Provider Demographics
NPI:1962651885
Name:ASHRAF ESKANDER A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ASHRAF ESKANDER A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ESKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-435-6162
Mailing Address - Street 1:700 E. REDLANDS BLVD #V345
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-435-6162
Mailing Address - Fax:909-792-9417
Practice Address - Street 1:2101 N. WATERMAN AVE.
Practice Address - Street 2:ASHRAF ESKANDER, A PROFESSIONAL MEDICAL CORPORATION
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-884-9091
Practice Address - Fax:909-792-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48837208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A488370Medicaid
CA00A488370Medicaid