=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487907770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AREA PSYCHIATRIC GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2012
-----------------------------------------------------
Last Update Date | 10/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5674 STONERIDGE DR STE 116
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-8536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-463-5674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5674 STONERIDGE DR STE 116
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-8536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-463-5674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MOHSIN R KHALIQUE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 925-463-5674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A98212
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------