Provider Demographics
NPI:1992970479
Name:QURESHI, TARANNUM S (PA-C)
Entity type:Individual
Prefix:
First Name:TARANNUM
Middle Name:S
Last Name:QURESHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:SUITE 292
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-449-4494
Mailing Address - Fax:626-449-4474
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:SUITE 292
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-449-4494
Practice Address - Fax:626-449-4474
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant