Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT32577 | CA |
NPI | 1922193739 |
---|---|
Provider Name | Iqbal S Maan |
First Address | Fountain Valley, CA 92728-8125 |
Second Address | Mountain View, CA 94043-1444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT32577 | STATE LICENSE (01) | CA |