MEDICARE: PLEASANTON MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1174618219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANTON MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5924 STONERIDGE DR STE 103
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5400
Country	:	US
Telephone Number	:	925-417-7505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 STONERIDGE DR STE 103
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5400
Country	:	US
Telephone Number	:	925-417-7505
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IQBAL INAYAT OMARALI
Credential	:	M.D.
Telephone Number	:	925-417-7505

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/17/2022

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Directions to “PLEASANTON MEDICAL GROUP ” Practice Location

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