Healthcare Provider Details

I. General information

NPI: 1114041316
Provider Name (Legal Business Name): SHAMS IQBAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LIME ST STE 714
RIVERSIDE CA
92501-2978
US

IV. Provider business mailing address

3600 LIME ST STE 714
RIVERSIDE CA
92501-2978
US

V. Phone/Fax

Practice location:
  • Phone: 951-367-1060
  • Fax: 951-686-5282
Mailing address:
  • Phone: 951-367-1060
  • Fax: 951-686-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA69076
License Number StateCA

VIII. Authorized Official

Name: MRS. NIGHAT SHERE
Title or Position: OFFICE MANAGER
Credential: NP
Phone: 95133671060