Healthcare Provider Details

I. General information

NPI: 1902858194
Provider Name (Legal Business Name): MUBASHIR AHMAD FAROOQI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

855 N EUCLID AVE
ONTARIO CA
91762-2729
US

V. Phone/Fax

Practice location:
  • Phone: 760-955-1777
  • Fax:
Mailing address:
  • Phone: 909-983-2020
  • Fax: 909-983-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA56486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: