Healthcare Provider Details

I. General information

NPI: 1295392686
Provider Name (Legal Business Name): FAISAL URAIZEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HONOLULU AVE STE 128
MONTROSE CA
91020-1800
US

IV. Provider business mailing address

2490 HONOLULU AVE STE 128
MONTROSE CA
91020-1800
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-9960
  • Fax:
Mailing address:
  • Phone: 818-330-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA179992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: