1093682098 NPI number — NORTHERN CALIFORNIA ADOLESCENT SPECIALTY CENTER

Table of content: BUSHRA FAZILI M.D. (NPI 1750399028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093682098 NPI number — NORTHERN CALIFORNIA ADOLESCENT SPECIALTY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN CALIFORNIA ADOLESCENT SPECIALTY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093682098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 BANCROFT RD # 231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-891-3272
Provider Business Mailing Address Fax Number:
925-891-3356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 SUMMIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-4734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-891-3272
Provider Business Practice Location Address Fax Number:
925-891-3356
Provider Enumeration Date:
10/22/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MESHERIAKOVA
Authorized Official First Name:
VERONIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-952-5550

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com