Provider Demographics
NPI:1548439524
Name:FADDOUL, DIALA (MD)
Entity type:Individual
Prefix:DR
First Name:DIALA
Middle Name:
Last Name:FADDOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2218
Mailing Address - Country:US
Mailing Address - Phone:323-987-2000
Mailing Address - Fax:323-987-1448
Practice Address - Street 1:2411 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2218
Practice Address - Country:US
Practice Address - Phone:323-987-2000
Practice Address - Fax:323-987-1448
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics