Healthcare Provider Details

I. General information

NPI: 1700237682
Provider Name (Legal Business Name): ADNAN FAEZ HAQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 DUBLIN BLVD
DUBLIN CA
94568-3112
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 925-875-6100
  • Fax:
Mailing address:
  • Phone: 925-875-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125068251
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.38396
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA177982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: