FAROOQUE AZAM NPI 1689203093

NPI Information

NPI: 1689203093
Provider Name: FAROOQUE AZAM
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
12450 VAN NUYS BLVD STE 200
PACOIMA, CA
ZIP 91331
Phone: (818) 896-1161
Get Directions

Farooque Azam is a psychiatric/mental health nurse practitioner in Pacoima, CA with 5 years of experience. Farooque Azam NPI is 1689203093. 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:

12450 VAN NUYS BLVD STE 200
PACOIMA, CA
ZIP 91331-393
Phone: (818) 896-1161
Fax: (818) 896-5069

The NPI 1689203093 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), Power Mobility Devices.

The enumeration date for this NPI number is 4/7/2020 and was last updated on 4/10/2023.

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	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	95014104	CALIFORNIA	Yes
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	65014104	CALIFORNIA	No

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	6758	MEDICAID	CALIFORNIA
2	7420	MEDICAID	CALIFORNIA
3	7068	MEDICAID	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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