Healthcare Provider Details

I. General information

NPI: 1972827806
Provider Name (Legal Business Name): KAMBIZ SHETABI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MEDICAL CENTER CT STE 10
CHULA VISTA CA
91911-6634
US

IV. Provider business mailing address

3131 BERGER AVE STE 200
SAN DIEGO CA
92123-4203
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-0300
  • Fax: 858-682-2202
Mailing address:
  • Phone: 858-244-6800
  • Fax: 858-244-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA126187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA126187
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number56405
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR8102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: