Provider Demographics
NPI:1396736245
Name:FARAJ, WALID AMIN (DO)
Entity type:Individual
Prefix:DR
First Name:WALID
Middle Name:AMIN
Last Name:FARAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2002
Mailing Address - Country:US
Mailing Address - Phone:530-896-9400
Mailing Address - Fax:530-896-9407
Practice Address - Street 1:845 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2002
Practice Address - Country:US
Practice Address - Phone:530-896-9400
Practice Address - Fax:530-896-9407
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84612Medicare UPIN
CA020A82051Medicare ID - Type Unspecified