Provider Demographics
NPI:1336767326
Name:QAZIZADA FOUNDATION LLC
Entity Type:Organization
Organization Name:QAZIZADA FOUNDATION LLC
Other - Org Name:QAZIZADA FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WALI
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:HANIFZAI
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:310-985-3845
Mailing Address - Street 1:PO BOX 10913
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0913
Mailing Address - Country:US
Mailing Address - Phone:310-985-3845
Mailing Address - Fax:
Practice Address - Street 1:2854 N SANTIAGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-1700
Practice Address - Country:US
Practice Address - Phone:310-985-3845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty