Provider Demographics
NPI:1689838641
Name:HAQUE, DILRUBA NISAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DILRUBA
Middle Name:NISAR
Last Name:HAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DILRUBA
Other - Middle Name:
Other - Last Name:NISAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DILRUBA NISAR MD
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 HOSPITAL RD STE 610
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3508
Practice Address - Country:US
Practice Address - Phone:949-999-1400
Practice Address - Fax:949-478-8185
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96156207R00000X, 207RX0202X, 207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology