MEDICARE: DR. ASHRAF A TAHA ASH TAHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	136178	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208VP0014X	Interventional Pain Medicine Physician	136178	CA

General Provider Information

NPI Number	:	1770729022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHRAF A TAHA ASH TAHA

Provider Business Mailing Address
First Line	:	120 TUSTIN AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4729
Country	:	US
Telephone Number	:	917-749-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 TUSTIN AVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4729
Country	:	US
Telephone Number	:	917-749-7474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	09/26/2019

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