Provider Demographics
NPI:1649492356
Name:FAROOQ, SYED U
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:U
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4000
Mailing Address - Country:US
Mailing Address - Phone:925-809-7920
Mailing Address - Fax:925-809-7928
Practice Address - Street 1:9100 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4000
Practice Address - Country:US
Practice Address - Phone:925-809-7920
Practice Address - Fax:925-809-7928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070024ANOtherSTATE CERT-ANTIOCH
CA070024BNOtherSTATE CERT - BRENTWOOD
CA56679OtherSTAFF ID NUMBER
CA0753OtherDRUG MEDI-CAL BILLING NO
CA07551OtherBRENTWOOD ADULT BILLING
CA07556OtherBYRON RANCH BILLING
CA07555OtherDRUG CT BILLING
CA070753OtherMASTER PROVIDER FILE NO
CA07531OtherANTIOCH ADULT BILLING
CA07533OtherANTIOCH ADOL BILLING
CA07553OtherBRENTWOOD ADOL BILLING