Healthcare Provider Details

I. General information

NPI: 1134393986
Provider Name (Legal Business Name): AZRA ABIDA ASHRAF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR STE 207
NEWPORT BEACH CA
92660-7820
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 207
NEWPORT BEACH CA
92660-7820
US

V. Phone/Fax

Practice location:
  • Phone: 949-877-7910
  • Fax:
Mailing address:
  • Phone: 714-547-3346
  • Fax: 714-547-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD81566
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAS4148501 E226121
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberD81566
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD439621
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: