Provider Demographics
NPI:1245320027
Name:HUSAIN, ISHRAT (MD)
Entity type:Individual
Prefix:DR
First Name:ISHRAT
Middle Name:
Last Name:HUSAIN
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 1:7365 CARNELIAN ST
Mailing Address - Street 2:STE #137
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1100
Mailing Address - Country:US
Mailing Address - Phone:909-948-8888
Mailing Address - Fax:909-948-8839
Practice Address - Street 1:7365 CARNELIAN ST
Practice Address - Street 2:STE #137
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1100
Practice Address - Country:US
Practice Address - Phone:909-948-8888
Practice Address - Fax:909-948-8839
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39629207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C396290Medicaid
CAA89106Medicare UPIN
CA00C396290Medicaid