Provider Demographics
NPI:1528264660
Name:MUMTAZ, SEEMAL (MD)
Entity type:Individual
Prefix:DR
First Name:SEEMAL
Middle Name:
Last Name:MUMTAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 K ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6992
Mailing Address - Country:US
Mailing Address - Phone:619-421-1111
Mailing Address - Fax:619-421-1504
Practice Address - Street 1:350 K ST UNIT 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6992
Practice Address - Country:US
Practice Address - Phone:619-421-1111
Practice Address - Fax:619-421-1504
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5401208600000X
CAA115758208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM056ZOtherMEDICARE PTAN