Healthcare Provider Details

I. General information

NPI: 1407897093
Provider Name (Legal Business Name): ABDUL MUSTAJEEB HASEEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABDUL MUSTAJEEB HASEEB M.D.

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 N MILLBROOK AVE
FRESNO CA
93720-3347
US

IV. Provider business mailing address

PO BOX 25100
FRESNO CA
93729-5100
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-1222
  • Fax: 559-326-1230
Mailing address:
  • Phone: 559-326-1222
  • Fax: 559-326-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA76480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: