Provider Demographics
NPI:1528087178
Name:MIRZA, FAISAL M (MD, FRCSC)
Entity type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:M
Last Name:MIRZA
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Gender:M
Credentials:MD, FRCSC
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Mailing Address - Street 1:65 NEILSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-728-4227
Mailing Address - Fax:831-728-0410
Practice Address - Street 1:1820 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3092
Practice Address - Country:US
Practice Address - Phone:831-728-4227
Practice Address - Fax:831-728-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85343207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine