Provider Demographics
NPI:1942308135
Name:TARIQ, NAILA ASHRAF (MD)
Entity Type:Individual
Prefix:
First Name:NAILA
Middle Name:ASHRAF
Last Name:TARIQ
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 1:1225 HANCOCK RD
Mailing Address - Street 2:SUITE # B
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5948
Mailing Address - Country:US
Mailing Address - Phone:928-758-0183
Mailing Address - Fax:928-758-6665
Practice Address - Street 1:1225 HANCOCK RD
Practice Address - Street 2:SUITE # B
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-758-0183
Practice Address - Fax:928-758-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31594208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ788531Medicaid
AZ788531Medicaid
CAZ 77102Medicare ID - Type Unspecified