MEDICARE: DR. IMTIAZ SIRAJ BASRAI M.D.

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	2084P0800X	Psychiatry Physician	A036962	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	A036962	CA
3	2084P0805X	Geriatric Psychiatry Physician	A036962	CA

General Provider Information

NPI Number	:	1497843544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMTIAZ SIRAJ BASRAI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4309
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-0309
Country	:	US
Telephone Number	:	626-229-3822
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 E COLORADO BLVD
Second Line	:	8TH.FLOOR
City	:	PASADENA
State	:	CA
Zip	:	91101-2044
Country	:	US
Telephone Number	:	626-229-3822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/11/2025

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