Healthcare Provider Details

I. General information

NPI: 1033111471
Provider Name (Legal Business Name): EMAD SHAFIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10014 ROSEDALE HWY
BAKERSFIELD CA
93312-2616
US

IV. Provider business mailing address

10014 ROSEDALE HWY
BAKERSFIELD CA
93312-2616
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-1600
  • Fax:
Mailing address:
  • Phone: 661-215-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: