NPIMap

Organization Active NPI

Abdo J. Faddoul, M.D. a Prof Corp

  • Urology Physician
  • Roseville, CA
National Provider Identifier
1134434764
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A41062 Issued in CA
Legal business name
ABDO J. FADDOUL, M.D. A PROF CORP
Practice address
2 Medical Plaza
Suite 285
Roseville, CA 95661
Phone
(916) 786-3100
Fax
(916) 786-9433
NPI assigned
Aug 6, 2010
Last updated
Aug 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Abdo Joseph Faddoul, M.D.NPI 1194717066
Title
President-Owner
Phone
(916) 786-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X A41062 CA Primary

Addresses

Primary practice location

2 Medical Plaza
Suite 285
Roseville, CA 95661

Mailing address

2 Medical Plaza
Suite 285
Roseville, CA 95661
Phone (916) 786-3100

National Provider Directory

National Provider Directory

Locations

2 Medical Plaza Dr
Ste 285
Roseville, CA 95661
Phone (916) 786-3100

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1134434764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA",
            "address_2": "SUITE 285",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-786-3100",
            "fax_number": "916-786-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA",
            "address_2": "SUITE 285",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-786-3100",
            "fax_number": "916-786-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABDO J. FADDOUL, M.D. A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-06",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "FADDOUL",
        "authorized_official_first_name": "ABDO",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT-OWNER",
        "authorized_official_telephone_number": "916-786-3100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "A41062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.