Provider Demographics
NPI:1922444306
Name:ISLAM, FARINA (MD)
Entity Type:Individual
Prefix:
First Name:FARINA
Middle Name:
Last Name:ISLAM
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 1:15706 POMERADO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2032
Mailing Address - Country:US
Mailing Address - Phone:858-485-0130
Mailing Address - Fax:858-485-9424
Practice Address - Street 1:15706 POMERADO RD STE 110
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-485-0130
Practice Address - Fax:858-485-9424
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2157597207V00000X
CA155812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2157597OtherM.D.-EDUCATIONAL LIMITED LICENSE