TAD FENNAR DPM NPI 1134151194

NPI Information

NPI: 1134151194
Provider Name: TAD FENNAR, DPM
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

PECOS Registration: Yes

Address:
1300 W 6TH ST
SUITE 2
SAN PEDRO, CA
ZIP 90732
Phone: (310) 831-0728
Get Directions

Tad Fennar, DPM is a foot and ankle surgery podiatrist in San Pedro, CA. Tad Fennar, DPM NPI is 1134151194. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1300 W 6TH ST
SUITE 2
SAN PEDRO, CA
ZIP 90732-531
Phone: (310) 831-0728
Fax: (310) 831-8564

The NPI 1134151194 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/7/2006 and was last updated on 10/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	E4107	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	U72683	MEDICARE UPIN	CALIFORNIA
2	000E41070	MEDICAID	CALIFORNIA
3	E4107	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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