Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A31910 | CA |
NPI | 1003926973 |
---|---|
Provider Name | Farooq Jameel Husayn |
First Address | Portland, TX 78374-3202 |
Second Address | Portland, TX 78374-3202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A319100 | (05) | CA |
A26639 | (02) | CA |