Healthcare Provider Details

I. General information

NPI: 1710210232
Provider Name (Legal Business Name): FURQAN ABBAS RAJA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 4TH ST
TAFT CA
93268-2415
US

IV. Provider business mailing address

615 DOUGLAS ST STE 500
DURHAM NC
27705-6616
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax: 661-459-1974
Mailing address:
  • Phone: 919-908-9730
  • Fax: 919-797-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04374
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: