Provider Demographics
NPI:1598875239
Name:AL-ASADI, GHADA OTHMAN (MD)
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:OTHMAN
Last Name:AL-ASADI
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 1:415 W ROUTE 66
Mailing Address - Street 2:STE 202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4335
Mailing Address - Country:US
Mailing Address - Phone:626-963-4467
Mailing Address - Fax:626-963-9543
Practice Address - Street 1:415 W ROUTE 66
Practice Address - Street 2:STE 202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC505872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG3431OtherBCBS
LA1991660Medicaid
LA5R902Medicare ID - Type Unspecified
LA1991660Medicaid