Provider Demographics
NPI:1093883886
Name:UBHAYAKAR, ASHA NAYAK (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:NAYAK
Last Name:UBHAYAKAR
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 1:1157 WEST 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784
Mailing Address - Country:US
Mailing Address - Phone:909-981-2781
Mailing Address - Fax:
Practice Address - Street 1:1157 WEST 22ND STREET
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784
Practice Address - Country:US
Practice Address - Phone:909-981-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A372541Medicaid
F03160Medicare UPIN
CA00A372541Medicaid