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General NPI Number Information
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NPI Number | 1962429571
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Entity Type | Individual
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Provider Name | FAZILATH FATIMA MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 17360 BROOKHURST ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3720
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Country | US
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Telephone | 657-241-3592
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Fax |
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Provider Business Mailing Address
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Address Line | 17360 BROOKHURST ST ATTN: CREDENTIALING DEPARTMENT
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301079615
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 4301079615
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.097068
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | C133691
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C133691
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License Number State | CA
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