Fennar, Tad

Fennar, Tad is an sole proprietor health care provider with primary practice located at 1300 W 6Th St Suite 2, San Pedro CA 90732-3531. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Fennar, Tad can be contacted via phone (310) 831-0728.

Contact Information

Primary practice address
1300 W 6Th St Suite 2 San Pedro CA 90732-3531
Phone: (310) 831-0728
Fax: (310) 831-8564
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X E4107 California

Profile Details

NPI number 1134151194
LBN Legal business name Fennar, Tad
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 7th, 2006
Last updated Oct 15th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134151194 NPPES
California MEDICAID 000E41070

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