Provider Demographics
NPI:1801477062
Name:IFTIKHAR, MAHROSE (DO)
Entity type:Individual
Prefix:DR
First Name:MAHROSE
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 PARKGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7717
Mailing Address - Country:US
Mailing Address - Phone:415-881-0802
Mailing Address - Fax:
Practice Address - Street 1:1035 PLACER ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1170
Practice Address - Country:US
Practice Address - Phone:530-246-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program