Provider Demographics
NPI:1457313017
Name:ASSASSA-SOLH, GHADA M (MD)
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:M
Last Name:ASSASSA-SOLH
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 1:2024 FOX HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6046
Mailing Address - Country:US
Mailing Address - Phone:626-915-6281
Mailing Address - Fax:
Practice Address - Street 1:210 W SAN BERNARDINO RD
Practice Address - Street 2:NUCLEAR MEDICINE DEPT
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1515
Practice Address - Country:US
Practice Address - Phone:626-915-6281
Practice Address - Fax:626-859-5825
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA501962085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501960Medicaid
CA00A501960OtherBLUE SHIELD
CAWA50196BMedicare PIN
CAW19154Medicare PIN
CA00A501960OtherBLUE SHIELD