Healthcare Provider Details

I. General information

NPI: 1447539127
Provider Name (Legal Business Name): MUMTAZ LAKHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MUMTAZ LAKHANI M.D.

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 DYLAN PL
PORTER RANCH CA
91326-2166
US

IV. Provider business mailing address

11401 DYLAN PL
PORTER RANCH CA
91326-2166
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-3022
  • Fax:
Mailing address:
  • Phone: 818-366-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA85685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: