Healthcare Provider Details

I. General information

NPI: 1043331192
Provider Name (Legal Business Name): IQBAL MAHMOOD MIRZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HIGHWAY
MONTEREY CA
93940
US

IV. Provider business mailing address

PO BOX 3612
SARATOGA CA
95070-1612
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax:
Mailing address:
  • Phone: 408-844-9670
  • Fax: 408-516-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberG82045
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG82045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: