Healthcare Provider Details

I. General information

NPI: 1689838641
Provider Name (Legal Business Name): DILRUBA NISAR HAQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DILRUBA NISAR DILRUBA NISAR M.D.

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 HOSPITAL RD STE 610
NEWPORT BEACH CA
92663-3508
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-1400
  • Fax: 949-478-8185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96156
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA96156
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA96156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: