1366844060 NPI number — OUR COMMON GROUND, INC. - EPA

Table of content: DR. AZFAR DUZA HOSSAIN MD (NPI 1043912702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366844060 NPI number — OUR COMMON GROUND, INC. - EPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR COMMON GROUND, INC. - EPA
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:
1366844060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
631 WOODSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94061-3847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-364-7988
Provider Business Mailing Address Fax Number:
650-364-7987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2560 PULGAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94303-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-325-6466
Provider Business Practice Location Address Fax Number:
650-325-6467
Provider Enumeration Date:
09/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ROACHE
Authorized Official First Name:
ORVILLE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
650-364-7988

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  410012CN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410012CN . This is a "DEPARTMENT OF HEALTH CARE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com