Healthcare Provider Details

I. General information

NPI: 1174618219
Provider Name (Legal Business Name): PLEASANTON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 STONERIDGE DR STE 103
PLEASANTON CA
94588-5400
US

IV. Provider business mailing address

5924 STONERIDGE DR STE 103
PLEASANTON CA
94588-5400
US

V. Phone/Fax

Practice location:
  • Phone: 925-417-7505
  • Fax:
Mailing address:
  • Phone: 925-417-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IQBAL INAYAT OMARALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-417-7505