Healthcare Provider Details

I. General information

NPI: 1932815198
Provider Name (Legal Business Name): AZRA ASHRAF MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
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: 949-877-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NITA DIAZ
Title or Position: BILLING MANAGER
Credential:
Phone: 714-547-3346