Azam, Farooque

Azam, Farooque is an individual health care provider with primary practice located at 12450 Van Nuys Blvd Ste 200 , Pacoima CA 91331-1393. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Azam, Farooque can be contacted via phone (818) 896-1161.

Contact Information

Primary practice address
12450 Van Nuys Blvd Ste 200 Pacoima CA 91331-1393
Phone: (818) 896-1161
Fax: (818) 896-5069
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 95014104 California
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 65014104 California

Profile Details

NPI number 1689203093
LBN Legal business name Azam, Farooque
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2020
Last updated Apr 10th, 2023 - about last year

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 1689203093 NPPES
California MEDICAID 6758
California MEDICAID 7420
California MEDICAID 7068

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