Provider Demographics
NPI:1770912438
Name:HAQUE-SHABBIR, HERA (MS, CGC)
Entity type:Individual
Prefix:
First Name:HERA
Middle Name:
Last Name:HAQUE-SHABBIR
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:HERA
Other - Middle Name:
Other - Last Name:HAQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:400 DAVEY GLEN RD
Mailing Address - Street 2:#4406
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2151
Mailing Address - Country:US
Mailing Address - Phone:415-713-2518
Mailing Address - Fax:
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:SUITE 231
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-404-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GC000469170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS