Provider Demographics
NPI:1720184898
Name:FAROOQ, MUHAMMAD A (MD, MPH, MBA, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:A
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD, MPH, MBA, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1841
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-0991
Mailing Address - Country:US
Mailing Address - Phone:951-737-2683
Mailing Address - Fax:951-273-2318
Practice Address - Street 1:3777 COOLHEIGHTS DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6234
Practice Address - Country:US
Practice Address - Phone:310-377-7736
Practice Address - Fax:310-427-7730
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH36374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER