Provider Demographics
NPI:1245335504
Name:WAHEED, NUZHAT FARZANA (DPM)
Entity type:Individual
Prefix:DR
First Name:NUZHAT
Middle Name:FARZANA
Last Name:WAHEED
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S BEACH BLVD
Mailing Address - Street 2:#F609
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1103
Mailing Address - Country:US
Mailing Address - Phone:562-947-8283
Mailing Address - Fax:
Practice Address - Street 1:2234 S EUCLID AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6501
Practice Address - Country:US
Practice Address - Phone:909-983-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4284213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42840Medicaid
CA000E42840Medicare ID - Type Unspecified
CAU91539Medicare UPIN