Healthcare Provider Details

I. General information

NPI: 1356309504
Provider Name (Legal Business Name): SHATHA BAKIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 BEAR VALLEY RD
APPLE VALLEY CA
92308-5148
US

IV. Provider business mailing address

12550 HESPERIA RD SUITE 100
VICTORVILLE CA
92395-5873
US

V. Phone/Fax

Practice location:
  • Phone: 760-240-3784
  • Fax: 760-247-4368
Mailing address:
  • Phone: 760-241-6666
  • Fax: 760-241-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA49522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: