1871798009 NPI number — DR. HALA Z. SHAKIR

Table of content: DR. HALA Z. SHAKIR (NPI 1871798009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871798009 NPI number — DR. HALA Z. SHAKIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAKIR
Provider First Name:
HALA
Provider Middle Name:
Z.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871798009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10804 RISING SMOKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89123-4677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-480-3000
Provider Business Mailing Address Fax Number:
714-571-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69160 RAMON ROAD
Provider Second Line Business Practice Location Address:
STUITE #100
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-3343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-969-5469
Provider Business Practice Location Address Fax Number:
760-770-0280
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  55755 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D55755 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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