Healthcare Provider Details

I. General information

NPI: 1942202825
Provider Name (Legal Business Name): TAHIRA AKRAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W LA VERNE AVE SUITE B
POMONA CA
91767-2347
US

IV. Provider business mailing address

175 W LA VERNE AVE SUITE B
POMONA CA
91767-2347
US

V. Phone/Fax

Practice location:
  • Phone: 909-593-4400
  • Fax: 909-593-4426
Mailing address:
  • Phone: 909-593-4400
  • Fax: 909-593-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036116791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: