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General NPI Number Information
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NPI Number | 1942308135
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Entity Type | Individual
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Provider Name | NAILA ASHRAF TARIQ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1225 HANCOCK RD SUITE # B
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-5948
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Country | US
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Telephone | 928-758-0183
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Fax | 928-758-6665
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Provider Business Mailing Address
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Address Line | 1225 HANCOCK RD SUITE # B
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-5948
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Country | US
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Telephone | 928-758-0183
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Fax | 928-758-6665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31594
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License Number State | AZ
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