Organization
SOUTHERN CALIFORNIA RIVIERA
Active
Organization
SOUTHERN CALIFORNIA RIVIERA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADY KADIFA M.D. (PRESIDENT)
(949) 452-0061
Entity
Organization
Contact information
Practice address
24411 HEALTH CENTER DR, STE 560, LAGUNA HILLS, CA 92653-3651
(949) 452-0061
Mailing address
24411 HEALTH CENTER DR STE 560, LAGUNA HILLS, CA 92653-3687
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A508220
—
CA
01
—
DC4641
MEDICARE RAILROAD
—
Enumeration date
09/20/2006
Last updated
01/14/2013
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