Basic Information
| Provider Information | |||||||||
| NPI: | 1518414366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAIQ | ||||||||
| FirstName: | JAMILA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.N-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25100 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937295100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593261238 | ||||||||
| FaxNumber: | 5593261230 | ||||||||
| Practice Location | |||||||||
| Address1: | 838 NORDAHL RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920693599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607478935 | ||||||||
| FaxNumber: | 7604660078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 781318 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95004759 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 95004759 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 95004759 | 01 | CA | CA MEDICAL LICENSE | OTHER |