Healthcare Provider Details

I. General information

NPI: 1750389375
Provider Name (Legal Business Name): HUMA TARIQ KHALIQ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BORDER AVE
TORRANCE CA
90501-3606
US

IV. Provider business mailing address

121 PIERCE BLVD
WINDSOR CT
06095-4744
US

V. Phone/Fax

Practice location:
  • Phone: 844-443-6246
  • Fax: 833-907-2235
Mailing address:
  • Phone: 203-449-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001554
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: