Healthcare Provider Details

I. General information

NPI: 1609726751
Provider Name (Legal Business Name): MISURGICAL MULTISPECIALTY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29300 PORTOLA PKWY STE B
LAKE FOREST CA
92630-8741
US

IV. Provider business mailing address

29300 PORTOLA PKWY STE B
LAKE FOREST CA
92630-8741
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-3134
  • Fax: 949-612-0857
Mailing address:
  • Phone: 949-916-3134
  • Fax: 949-612-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AFZAAL IQBAL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-916-3134