Healthcare Provider Details

I. General information

NPI: 1477648079
Provider Name (Legal Business Name): FAZEELA FEROUZ MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10760 WARNER AVE STE 102
FOUNTAIN VALLEY CA
92708-3845
US

IV. Provider business mailing address

PO BOX 4259
CERRITOS CA
90703-4259
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-0388
  • Fax:
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG85633
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG85633
License Number StateCA

VIII. Authorized Official

Name: DR. FAZEELA FEROUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-599-4509