Provider Demographics
NPI:1366514499
Name:IQBAL, SHAHEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3623
Mailing Address - Country:US
Mailing Address - Phone:323-728-6445
Mailing Address - Fax:323-728-9804
Practice Address - Street 1:609 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3623
Practice Address - Country:US
Practice Address - Phone:323-728-6445
Practice Address - Fax:323-728-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38557OtherMEDICARE PROVIDER NUMBER
CA00A385570OtherMEDI-CAL PROVIDER NUMBER
CAA38557OtherMEDICARE PROVIDER NUMBER
CAA85145Medicare UPIN