Provider Demographics
NPI:1891929287
Name:SHADI A. QASQAS MD, INC.
Entity Type:Organization
Organization Name:SHADI A. QASQAS MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:A
Authorized Official - Last Name:QASQAS
Authorized Official - Suffix:
Authorized Official - Credentials:A102826
Authorized Official - Phone:909-489-0727
Mailing Address - Street 1:1646 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1922
Mailing Address - Country:US
Mailing Address - Phone:909-489-0727
Mailing Address - Fax:
Practice Address - Street 1:1646 N PALM AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1922
Practice Address - Country:US
Practice Address - Phone:909-489-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102826207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty