Provider Demographics
NPI:1154302529
Name:ASSAAD, HEDY S (MD)
Entity Type:Individual
Prefix:
First Name:HEDY
Middle Name:S
Last Name:ASSAAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAHED
Other - Middle Name:SAAD
Other - Last Name:ASSAAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-782-3692
Mailing Address - Fax:951-784-3257
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2615
Practice Address - Country:US
Practice Address - Phone:951-782-3692
Practice Address - Fax:951-784-3257
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730180415OtherGROUP NPI
ZZZ31887XOtherSITE LOCATION FOR GROUP
00A431430Medicare ID - Type Unspecified
A29667Medicare UPIN