Provider Demographics
NPI:1184324428
Name:FURQAN, AISHA (MS, CGC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:FURQAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8659 N PAULA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5312
Mailing Address - Country:US
Mailing Address - Phone:510-565-2656
Mailing Address - Fax:
Practice Address - Street 1:900 BLAKE WILBUR DR
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2201
Practice Address - Country:US
Practice Address - Phone:650-304-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000675170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC00675OtherGENETIC COUNSELOR, MS