Provider Demographics
NPI:1730167867
Name:QAMAR, HISANA (MD)
Entity type:Individual
Prefix:
First Name:HISANA
Middle Name:
Last Name:QAMAR
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 1:19 UPPER RAGSDALE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7881
Mailing Address - Country:US
Mailing Address - Phone:831-373-1366
Mailing Address - Fax:
Practice Address - Street 1:851 S RAMPART BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4883
Practice Address - Country:US
Practice Address - Phone:855-211-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93696207Q00000X
NV14620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI25922Medicare UPIN
CAAS469Medicare PIN