1609100924 NPI number — SIMA SHAKIBA, M.D. INC.

Table of content: RICHARD REY STARK M.D. (NPI 1023104049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609100924 NPI number — SIMA SHAKIBA, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMA SHAKIBA, M.D. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1609100924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1223
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL MAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92014-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-232-9862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 ENCINITAS BLVD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-232-9862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAKIBA
Authorized Official First Name:
SIMA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
858-232-9862

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  A51469 , 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)