Provider Demographics
NPI:1104604776
Name:MCFADDEN, ERNEST
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:MCFADDEN
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 1:11401 VANDERGRIFT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7127
Mailing Address - Country:US
Mailing Address - Phone:316-990-7046
Mailing Address - Fax:
Practice Address - Street 1:11303 WILSHIRE BLVD BLDG 116
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5069
Practice Address - Country:US
Practice Address - Phone:316-990-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty