Healthcare Provider Details

I. General information

NPI: 1578515896
Provider Name (Legal Business Name): MUHAMMAD RAGHIB IQBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL SUITE 140
PASADENA CA
91105-3149
US

IV. Provider business mailing address

50 ALESSANDRO PL SUITE 140
PASADENA CA
91105-3149
US

V. Phone/Fax

Practice location:
  • Phone: 626-657-0863
  • Fax: 626-639-6075
Mailing address:
  • Phone: 626-657-0863
  • Fax: 626-639-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4444
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA94608
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberRS2012-0789
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA94608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: