Healthcare Provider Details

I. General information

NPI: 1437834934
Provider Name (Legal Business Name): HIBA NOORI SHAKIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST STE 200
EL CAJON CA
92020-3328
US

IV. Provider business mailing address

133 W MAIN ST STE 200
EL CAJON CA
92020-3328
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-0404
  • Fax:
Mailing address:
  • Phone: 619-401-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: