Provider Demographics
NPI:1811002082
Name:FARID, WAFAA M (MD)
Entity Type:Individual
Prefix:DR
First Name:WAFAA
Middle Name:M
Last Name:FARID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WAFAA
Other - Middle Name:M
Other - Last Name:FARID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1729 W AVENUE J STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2708
Mailing Address - Country:US
Mailing Address - Phone:661-949-5193
Mailing Address - Fax:661-949-6948
Practice Address - Street 1:1729 W. AVE. J. #101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-949-5193
Practice Address - Fax:661-949-6948
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist