1245898253 NPI number — RASHA GAMALELDIN ELBADRY AHMED M.D.

Table of content: RASHA GAMALELDIN ELBADRY AHMED M.D. (NPI 1245898253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245898253 NPI number — RASHA GAMALELDIN ELBADRY AHMED M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
RASHA
Provider Middle Name:
GAMALELDIN ELBADRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245898253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2023
NPI Reactivation Date:
05/26/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11234 ANDERSON STREET
Provider Second Line Business Mailing Address:
WESTERLY STE C
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-558-6131
Provider Business Mailing Address Fax Number:
720-777-7272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11234 ANDERSON STREET
Provider Second Line Business Practice Location Address:
WESTERLY STE C
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-558-6131
Provider Business Practice Location Address Fax Number:
720-777-7272
Provider Enumeration Date:
06/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: PTL8390 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39 . This is a "STUDENT, HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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