Individual
FAROOQUE AZAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12450 VAN NUYS BLVD STE 200, PACOIMA, CA 91331-1393
(818) 896-1161
(818) 896-5069
Mailing address
12450 VAN NUYS BLVD STE 200, PACOIMA, CA 91331-1393
(818) 896-1161
(818) 896-5069
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
65014104
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95014104
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6758
—
CA
05
—
7068
—
CA
05
—
7420
—
CA
Enumeration date
04/07/2020
Last updated
04/10/2023
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