Provider Demographics
NPI:1184661753
Name:QAZI, MUSTAQEEM AHMED (MD)
Entity Type:Individual
Prefix:MR
First Name:MUSTAQEEM
Middle Name:AHMED
Last Name:QAZI
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 1:82013 DR CARREON BLVD
Mailing Address - Street 2:C
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-863-0138
Mailing Address - Fax:760-863-0471
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:C
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-0138
Practice Address - Fax:760-863-0471
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41070Medicare UPIN
CA00A549780Medicare ID - Type Unspecified