Provider Demographics
NPI:1033370358
Name:TARIQ, SHAMAIL S (MD)
Entity Type:Individual
Prefix:
First Name:SHAMAIL
Middle Name:S
Last Name:TARIQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E VALENCIA MESA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3817
Mailing Address - Country:US
Mailing Address - Phone:714-446-5050
Mailing Address - Fax:
Practice Address - Street 1:100 E VALENCIA MESA DR STE 206
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3817
Practice Address - Country:US
Practice Address - Phone:714-446-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016007040207RI0011X
CAA116248207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology