Basic Information
| Provider Information | |||||||||
| NPI: | 1619330214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAQUE | ||||||||
| FirstName: | TAHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4966 EL CAMINO REAL | ||||||||
| Address2: | STE 224 | ||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506902362 | ||||||||
| FaxNumber: | 6505904938 | ||||||||
| Practice Location | |||||||||
| Address1: | 7559 263RD ST | ||||||||
| Address2: | |||||||||
| City: | GLEN OAKS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110041150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184708005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A168179 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.