Provider Demographics
NPI:1487679361
Name:FAISAL, FAWAZ (MD)
Entity Type:Individual
Prefix:
First Name:FAWAZ
Middle Name:
Last Name:FAISAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2216
Mailing Address - Country:US
Mailing Address - Phone:818-845-2255
Mailing Address - Fax:818-845-2828
Practice Address - Street 1:1218 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2216
Practice Address - Country:US
Practice Address - Phone:818-845-2255
Practice Address - Fax:818-845-2828
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA505452084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505450Medicaid
CA1649373622OtherNPI
CA00A505450Medicaid
CAF78453Medicare UPIN