Basic Information
| Provider Information | |||||||||
| NPI: | 1043331192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRZA | ||||||||
| FirstName: | IQBAL | ||||||||
| MiddleName: | MAHMOOD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3612 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950701612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4088449670 | ||||||||
| FaxNumber: | 4085169989 | ||||||||
| Practice Location | |||||||||
| Address1: | 23625 HOLMAN HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316245311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | G82045 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | G82045 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.