Healthcare Provider Details

I. General information

NPI: 1790886869
Provider Name (Legal Business Name): RAZA IQBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 YORBA LINDA BLVD SUITE G 558
YORBA LINDA CA
92887-3762
US

IV. Provider business mailing address

21520 YORBA LINDA BLVD SUITE G 558
YORBA LINDA CA
92887-3762
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-9697
  • Fax: 714-896-8757
Mailing address:
  • Phone: 714-896-9697
  • Fax: 714-896-8757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA53318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: