Provider Demographics
NPI:1003963489
Name:KHWAJA, ARIF
Entity Type:Individual
Prefix:MR
First Name:ARIF
Middle Name:
Last Name:KHWAJA
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 1:12240 179TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4249
Mailing Address - Country:US
Mailing Address - Phone:909-986-4506
Mailing Address - Fax:909-986-4506
Practice Address - Street 1:125 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3262
Practice Address - Country:US
Practice Address - Phone:909-986-4506
Practice Address - Fax:909-986-4506
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)