Healthcare Provider Details

I. General information

NPI: 1497732093
Provider Name (Legal Business Name): FAROOQ ABDULLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E CALVADA BLVD STE 200
PAHRUMP NV
89048-5852
US

IV. Provider business mailing address

PO BOX 98978
LAS VEGAS NV
89193-8978
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-4600
  • Fax: 775-751-2094
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6413
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number6413
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: