Healthcare Provider Details

I. General information

NPI: 1124480157
Provider Name (Legal Business Name): FARUQA SHARIFF LADHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20103 LAKE CHABOT RD EDEN MEDICAL CENTER
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

565 ARASTRADERO ROAD APT 105
PALO ALTO CA
94306-4320
US

V. Phone/Fax

Practice location:
  • Phone: 650-338-8443
  • Fax:
Mailing address:
  • Phone: 650-338-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number141146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: