Provider Demographics
NPI:1740498328
Name:QASQAS, SHADI ALI (MD)
Entity type:Individual
Prefix:DR
First Name:SHADI
Middle Name:ALI
Last Name:QASQAS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:31571 CANYON ESTATES DR
Mailing Address - Street 2:SUITE 228
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0471
Mailing Address - Country:US
Mailing Address - Phone:877-363-9590
Mailing Address - Fax:951-240-3715
Practice Address - Street 1:12223 HIGHLAND AVE
Practice Address - Street 2:STE 106-551
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2574
Practice Address - Country:US
Practice Address - Phone:877-363-9590
Practice Address - Fax:951-240-3715
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-05-02
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Provider Licenses
StateLicense IDTaxonomies
CAA102826207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24852ZMedicare UPIN