Provider Demographics
NPI:1659535318
Name:AQIL, WASIL MOHAMMAD (DO)
Entity Type:Individual
Prefix:
First Name:WASIL
Middle Name:MOHAMMAD
Last Name:AQIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:WASIL
Other - Last Name:AQIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:17284 SLOVER AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7584
Mailing Address - Country:US
Mailing Address - Phone:909-609-3562
Mailing Address - Fax:
Practice Address - Street 1:17284 SLOVER AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7584
Practice Address - Country:US
Practice Address - Phone:909-609-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine