Individual
FHARAK MAA CHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 EUCLID AVE, SUITE 303, NATIONAL CITY, CA 91950-2957
(619) 475-4900
(619) 475-8373
Mailing address
4225 EXECUTIVE SQ STE 450, LA JOLLA, CA 92037-8411
(858) 810-8025
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A117604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A117604
CA LICENSE
CA
01
—
CA124198
NO. CALIFORNIA PTAN
CA
01
—
CB216371
SO. CALIFORNIA PTAN
CA
Enumeration date
07/21/2011
Last updated
01/26/2021
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