Provider Demographics
NPI:1689641482
Name:FEROUZ, FAZEELA (MD)
Entity Type:Individual
Prefix:DR
First Name:FAZEELA
Middle Name:
Last Name:FEROUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:10760 WARNER AVE STE 102
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3845
Practice Address - Country:US
Practice Address - Phone:714-274-0388
Practice Address - Fax:714-647-1245
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85633207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G856330Medicaid
CAP00024894Medicare PIN
CA00G856330Medicaid
CA00G856330Medicare PIN
CACY783ZMedicare PIN