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General NPI Number Information
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NPI Number | 1629083191
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Entity Type | Individual
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Provider Name | SANDRA QASEEM MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 39765 DATE ST STE 102
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City | MURRIETA
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State | CA
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Zip | 92563-2005
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Country | US
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Telephone | 951-894-4665
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Fax | 951-894-5178
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Provider Business Mailing Address
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Address Line | 39765 DATE ST STE 102
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City | MURRIETA
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State | CA
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Zip | 92563-2005
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Country | US
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Telephone | 951-894-4665
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Fax | 951-894-5178
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 2004-0648
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License Number State | NM
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