Provider Demographics
NPI:1245898253
Name:AHMED, RASHA GAMALELDIN ELBADRY (MD)
Entity type:Individual
Prefix:
First Name:RASHA
Middle Name:GAMALELDIN ELBADRY
Last Name:AHMED
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 1:11234 ANDERSON STREET
Mailing Address - Street 2:WESTERLY STE C
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-6131
Mailing Address - Fax:720-777-7272
Practice Address - Street 1:11234 ANDERSON STREET
Practice Address - Street 2:WESTERLY STE C
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-6131
Practice Address - Fax:720-777-7272
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-05-26
Deactivation Date:2023-03-15
Deactivation Code:
Reactivation Date:2023-05-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPTL8390390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
39OtherSTUDENT, HEALTH CARE