Provider Demographics
NPI:1447660873
Name:HAYDER, AGHA ZULFEQUAR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:AGHA
Middle Name:ZULFEQUAR
Last Name:HAYDER
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 WEST 6TH STREET, SUITE B
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:909-984-0320
Mailing Address - Fax:909-984-2213
Practice Address - Street 1:1001 WEST 6TH STREET, SUITE B.
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-984-0320
Practice Address - Fax:909-984-2213
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner