Provider Demographics
NPI:1881910511
Name:FARUQUE, TANIA (BS, MBS, MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:FARUQUE
Suffix:
Gender:F
Credentials:BS, MBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3431
Mailing Address - Country:US
Mailing Address - Phone:760-489-1876
Mailing Address - Fax:607-489-1748
Practice Address - Street 1:255 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3431
Practice Address - Country:US
Practice Address - Phone:760-489-1876
Practice Address - Fax:607-489-1748
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128513208VP0000X, 207L00000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine