Healthcare Provider Details

I. General information

NPI: 1932064516
Provider Name (Legal Business Name): WALID FARAJ, D.O., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11121 LOS ALAMITOS BLVD STE 201
LOS ALAMITOS CA
90720-3889
US

IV. Provider business mailing address

11121 LOS ALAMITOS BLVD STE 201
LOS ALAMITOS CA
90720-3889
US

V. Phone/Fax

Practice location:
  • Phone: 714-230-2424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WALID FARAJ
Title or Position: MANAGER
Credential: DO
Phone: 714-230-2424