Provider Demographics
NPI:1285601252
Name:QURESHI, FARDA R (MD)
Entity type:Individual
Prefix:
First Name:FARDA
Middle Name:R
Last Name:QURESHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E REMINGTON DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2657
Mailing Address - Country:US
Mailing Address - Phone:408-730-2200
Mailing Address - Fax:408-730-4900
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:SUITE 15
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:408-730-2200
Practice Address - Fax:408-730-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0A53700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537000OtherMEDI-CAL PROVIDER NUMBER
CAG86865Medicare UPIN