Basic Information
| Provider Information | |||||||||
| NPI: | 1992018253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAQBOOL | ||||||||
| FirstName: | MUHAMMAD QASIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629774674 | ||||||||
| FaxNumber: | 5627414479 | ||||||||
| Practice Location | |||||||||
| Address1: | 4821 N STONE AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857045727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203143300 | ||||||||
| FaxNumber: | 5202931957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2010 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD61351065 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28000 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 28000 | OK | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 64188 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.