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General NPI Number Information
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NPI Number | 1003607938
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Entity Type | Individual
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Provider Name | TAYYAB WASEEM
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Gender | Male
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 9610 MILAN DR
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City | STOCKTON
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State | CA
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Zip | 95212-3514
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Country | US
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Telephone | 516-524-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 9610 MILAN DR
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City | STOCKTON
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State | CA
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Zip | 95212-3514
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Country | US
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Telephone | 516-524-9764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | W9174882
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License Number State | CA
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