MEDICARE: SHADI A. QASQAS MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A102826	CA

General Provider Information

NPI Number	:	1891929287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADI A. QASQAS MD, INC.

Provider Business Mailing Address
First Line	:	1646 N PALM AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1922
Country	:	US
Telephone Number	:	909-489-0727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1646 N PALM AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1922
Country	:	US
Telephone Number	:	909-489-0727
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	DR. SHADI A QASQAS
Credential	:	A102826
Telephone Number	:	909-489-0727

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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