Healthcare Provider Details

I. General information

NPI: 1588569750
Provider Name (Legal Business Name): MEHAK ISHAQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74401 HOVLEY LN E
PALM DESERT CA
92260-1702
US

IV. Provider business mailing address

7118 WALCOTT PL
RANCHO CUCAMONGA CA
91739-1803
US

V. Phone/Fax

Practice location:
  • Phone: 909-662-8364
  • Fax:
Mailing address:
  • Phone: 909-660-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: