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General NPI Number Information
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NPI Number | 1174618219
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Entity Type | Organization
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Legal Business Name | PLEASANTON MEDICAL GROUP
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 5924 STONERIDGE DR STE 103
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City | PLEASANTON
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State | CA
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Zip | 94588-5400
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Country | US
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Telephone | 925-417-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 STONERIDGE DR STE 103
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City | PLEASANTON
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State | CA
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Zip | 94588-5400
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Country | US
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Telephone | 925-417-7505
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IQBAL INAYAT OMARALI
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Credential | M.D.
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Telephone | 925-417-7505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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