Provider Demographics
NPI:1437414380
Name:IMAM, FARAH NIDA (MD)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:NIDA
Last Name:IMAM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:16465 SIERRA LAKES PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1242
Mailing Address - Country:US
Mailing Address - Phone:909-823-8000
Mailing Address - Fax:909-823-8088
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-823-8000
Practice Address - Fax:909-823-8088
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2024-07-22
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Provider Licenses
StateLicense IDTaxonomies
CAA132422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine