Provider Demographics
NPI:1215697370
Name:HAQ, RAHILA NASREEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:RAHILA
Middle Name:NASREEN
Last Name:HAQ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17321 MURPHY AVE APT 480
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8924
Mailing Address - Country:US
Mailing Address - Phone:734-934-7083
Mailing Address - Fax:
Practice Address - Street 1:100 N STATE COLLEGE BLVD STE H
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4236
Practice Address - Country:US
Practice Address - Phone:714-824-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner