Provider Demographics
NPI:1043414220
Name:AFTAB, WAQAS (MD)
Entity Type:Individual
Prefix:
First Name:WAQAS
Middle Name:
Last Name:AFTAB
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 1:1910 OUTLET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0677
Mailing Address - Country:US
Mailing Address - Phone:054-852-4008
Mailing Address - Fax:805-485-3025
Practice Address - Street 1:1600 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3722
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:805-485-3025
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99485207RN0300X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA99485OtherMEDICAL LICENSE
CA00A994850Medicaid
CAA99485OtherMEDICAL LICENSE
CA00A994851Medicare PIN