Healthcare Provider Details

I. General information

NPI: 1023941820
Provider Name (Legal Business Name): IQRA AFZAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 S HARLAN RD
LATHROP CA
95330-8738
US

IV. Provider business mailing address

8761 TERRACORVO CIR
STOCKTON CA
95212-3829
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT144013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: