| Doctor Name: | WALEED S. AL-FADLY |
| NPI Number: | 1215936224 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A20545 |
| Business Practice Address: | 16000 S Vermont Ave Gardena, CA - 902474552 |
| Business Phone Number: | 3103241331 |
| Business Fax Number: | 3103244358 |
| Mailing Address: | 16000 S Vermont Ave, GARDENA |
| State: | CA |
| Postal Code: | 902474552 |
| Phone Number: | 3103241331 |
| Fax Number: | 3103244358 |
| NPI Enumeration Date: | 07/20/2005 |
| NPI Last Update Date: | 02/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A20545 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |