Provider Demographics
NPI:1104013374
Name:GHADA ASSASSA-SOLH, M.D.,INC.
Entity Type:Organization
Organization Name:GHADA ASSASSA-SOLH, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSASSA-SOLH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-915-6256
Mailing Address - Street 1:210 W SAN BERNARDINO RD
Mailing Address - Street 2:DEPT. OF NUCLEAR MEDICINE
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1515
Mailing Address - Country:US
Mailing Address - Phone:626-915-6256
Mailing Address - Fax:626-859-5825
Practice Address - Street 1:210 W SAN BERNARDINO RD
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1515
Practice Address - Country:US
Practice Address - Phone:626-915-6256
Practice Address - Fax:626-859-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50196207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501960Medicaid
CA00A501960Medicaid