Healthcare Provider Details

I. General information

NPI: 1225738495
Provider Name (Legal Business Name): SANA QURESHI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 ROYALTY DR
POMONA CA
91767-3021
US

IV. Provider business mailing address

14122 PICASSO CT
IRVINE CA
92606-1824
US

V. Phone/Fax

Practice location:
  • Phone: 909-333-4941
  • Fax: 909-333-4941
Mailing address:
  • Phone: 949-812-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SANA QURESHI
Title or Position: CEO
Credential: MD
Phone: 949-812-2785