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General NPI Number Information
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NPI Number | 1447671185
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Entity Type | Organization
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Legal Business Name | IMAGIWILL MED CO
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Dates
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Enumeration Date | 12/24/2013
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Last Update Date | 12/24/2013
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Provider Practice Location Address
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Address Line | 1350 COLUMBIA ST SUITE 800
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City | SAN DIEGO
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State | CA
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Zip | 92101-3454
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Country | US
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Telephone | 619-356-1446
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Fax | 619-618-4530
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-464-1165
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Fax | 619-567-1011
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARAZ TAWFIQUE
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Credential | M.D.
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Telephone | 619-356-1446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A109527
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License Number State | CA
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