Provider Demographics
NPI:1669592473
Name:IQBAL, ATIF (MD)
Entity type:Individual
Prefix:
First Name:ATIF
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:18225 BROOKHURST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6719
Mailing Address - Country:US
Mailing Address - Phone:714-599-8222
Mailing Address - Fax:714-599-8223
Practice Address - Street 1:18225 BROOKHURST ST STE 5
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6719
Practice Address - Country:US
Practice Address - Phone:714-599-8222
Practice Address - Fax:714-599-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL98356208600000X
NE5358208600000X
NY251627208600000X
CAA 101690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104130Medicaid