Healthcare Provider Details

I. General information

NPI: 1184324428
Provider Name (Legal Business Name): AISHA FURQAN MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BLAKE WILBUR DR
PALO ALTO CA
94304-2201
US

IV. Provider business mailing address

8659 N PAULA AVE
FRESNO CA
93720-5312
US

V. Phone/Fax

Practice location:
  • Phone: 650-304-6970
  • Fax:
Mailing address:
  • Phone: 510-565-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: