Provider Demographics
NPI:1750038162
Name:FAROOQ, ANEES (LAC)
Entity Type:Individual
Prefix:
First Name:ANEES
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH ST STE 120-327
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5512
Mailing Address - Country:US
Mailing Address - Phone:602-877-1067
Mailing Address - Fax:
Practice Address - Street 1:2520 E UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-3143
Practice Address - Country:US
Practice Address - Phone:480-757-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02842171100000X
AZLAC-011985171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist