Healthcare Provider Details

I. General information

NPI: 1801045679
Provider Name (Legal Business Name): SUMBELLA FARHAN BAQAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. SUMBELLA FAROOQ

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W EATON AVE
TRACY CA
95376-3420
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-7408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA105374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: