Healthcare Provider Details

I. General information

NPI: 1952400871
Provider Name (Legal Business Name): FAZEELA H BAQAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LEAGUE UNIT 61303
IRVINE CA
92602-7060
US

IV. Provider business mailing address

1 LEAGUE UNIT 61303
IRVINE CA
92602-7060
US

V. Phone/Fax

Practice location:
  • Phone: 949-427-6989
  • Fax: 866-381-9560
Mailing address:
  • Phone: 949-427-6989
  • Fax: 866-381-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA49971
License Number StateCA

VIII. Authorized Official

Name: GLORIA RUIZ
Title or Position: PHYSICIAN PRACTICE MANAGER
Credential:
Phone: 505-216-4200