Basic Information
| Provider Information | |||||||||
| NPI: | 1316063688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADDAD | ||||||||
| FirstName: | HIKMAT | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 STATE ST APT 17 | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910302123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187554950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10526 DUBNOFF WAY | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187554950 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN156202 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.