Healthcare Provider Details

I. General information

NPI: 1225524002
Provider Name (Legal Business Name): MD ASHRAFUL HUQ RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S 2ND AVE
COVINA CA
91723-3012
US

IV. Provider business mailing address

3430 COGSWELL RD
EL MONTE CA
91732-2785
US

V. Phone/Fax

Practice location:
  • Phone: 626-974-8123
  • Fax: 626-974-8198
Mailing address:
  • Phone: 626-453-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: