Healthcare Provider Details

I. General information

NPI: 1235791765
Provider Name (Legal Business Name): FARZOOK FAYYAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 THE ALAMEDA STE 440
SAN JOSE CA
95126-1462
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-427-2778
  • Fax: 408-400-0437
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number184176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: