Provider Demographics
NPI:1093425605
Name:AODO, FADI
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:AODO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 W 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2016
Mailing Address - Country:US
Mailing Address - Phone:951-407-0707
Mailing Address - Fax:951-657-5481
Practice Address - Street 1:524 W 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2016
Practice Address - Country:US
Practice Address - Phone:951-407-0707
Practice Address - Fax:951-657-5481
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2025-08-27
Deactivation Date:2024-03-05
Deactivation Code:
Reactivation Date:2025-08-27
Provider Licenses
StateLicense IDTaxonomies
CA76295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist