Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | A84987 | CA |
NPI | 1639195654 |
---|---|
Provider Name | Tariq Mirza |
First Address | Modesto, CA 95357-0718 |
Second Address | Modesto, CA 95357-0718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |