Provider Demographics
NPI:1447671185
Name:IMAGIWILL MED CO
Entity type:Organization
Organization Name:IMAGIWILL MED CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWFIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-356-1446
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-464-1165
Mailing Address - Fax:619-567-1011
Practice Address - Street 1:1350 COLUMBIA ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3454
Practice Address - Country:US
Practice Address - Phone:619-356-1446
Practice Address - Fax:619-618-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1095272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty