Provider Demographics
NPI:1467984427
Name:FAIZY, RUBINA MUMTAZ (MD)
Entity Type:Individual
Prefix:
First Name:RUBINA
Middle Name:MUMTAZ
Last Name:FAIZY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUBINA
Other - Middle Name:M
Other - Last Name:HUSAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9327 FAIRWAY VIEW PL STE 204
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0969
Mailing Address - Country:US
Mailing Address - Phone:951-356-5414
Mailing Address - Fax:
Practice Address - Street 1:770 MAGNOLIA AVE STE 2F
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:951-356-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1643122084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program