Provider Demographics
NPI:1609609353
Name:FADDAH, NARDEEN
Entity type:Individual
Prefix:
First Name:NARDEEN
Middle Name:
Last Name:FADDAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 LEWIS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4698
Mailing Address - Country:US
Mailing Address - Phone:760-634-1125
Mailing Address - Fax:
Practice Address - Street 1:9191 JULIE BETH ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2638
Practice Address - Country:US
Practice Address - Phone:951-522-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY9005972106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician