Healthcare Provider Details

I. General information

NPI: 1922193739
Provider Name (Legal Business Name): IQBAL S MAAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PEAR AVE 101
MOUNTAIN VIEW CA
94043-1444
US

IV. Provider business mailing address

PO BOX 8125
FOUNTAIN VALLEY CA
92728-8125
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-8434
  • Fax: 650-965-8545
Mailing address:
  • Phone: 650-965-8434
  • Fax: 650-965-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT32577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: