Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1649492356 |
---|---|
Provider Name | Syed U. Farooq |
First Address | Brentwood, CA 94513-4000 |
Second Address | Brentwood, CA 94513-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070024AN | STATE CERT-ANTIOCH (01) | CA |
070024BN | STATE CERT - BRENTWOOD (01) | CA |
070753 | MASTER PROVIDER FILE NO (01) | CA |
0753 | DRUG MEDI-CAL BILLING NO (01) | CA |
07531 | ANTIOCH ADULT BILLING (01) | CA |
07533 | ANTIOCH ADOL BILLING (01) | CA |
07551 | BRENTWOOD ADULT BILLING (01) | CA |
07553 | BRENTWOOD ADOL BILLING (01) | CA |
07555 | DRUG CT BILLING (01) | CA |
07556 | BYRON RANCH BILLING (01) | CA |
56679 | STAFF ID NUMBER (01) | CA |