Healthcare Provider Details

I. General information

NPI: 1376978742
Provider Name (Legal Business Name): SAQIB IQBAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER RD STE 110
CERRITOS CA
90703-2521
US

IV. Provider business mailing address

12333 195TH ST
ARTESIA CA
90701-7703
US

V. Phone/Fax

Practice location:
  • Phone: 562-716-6726
  • Fax: 562-735-3913
Mailing address:
  • Phone: 562-716-6726
  • Fax: 562-860-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW62535
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW78705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: