Healthcare Provider Details

I. General information

NPI: 1356385215
Provider Name (Legal Business Name): ADELA ASHRAF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 IRVINE BLVD STE 208
TUSTIN CA
92780-3424
US

IV. Provider business mailing address

5 JOURNEY 210
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

Practice location:
  • Phone: 714-371-9000
  • Fax:
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: