Provider Demographics
NPI:1245486711
Name:MEDICAL CONSULTANTS OF AMERICA A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MEDICAL CONSULTANTS OF AMERICA A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUJEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAF
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS;MRCP
Authorized Official - Phone:707-481-0537
Mailing Address - Street 1:2777 YULUPA AVE
Mailing Address - Street 2:#402
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8584
Mailing Address - Country:US
Mailing Address - Phone:707-481-0537
Mailing Address - Fax:
Practice Address - Street 1:1165 MONTGOMERY DR
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4801
Practice Address - Country:US
Practice Address - Phone:707-481-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103416208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty