Healthcare Provider Details

I. General information

NPI: 1811802184
Provider Name (Legal Business Name): HOOMAN MOHAMMAD SHAFIEI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE STE 104
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

1501 E GRAND AVE APT 2301
ESCONDIDO CA
92027-3170
US

V. Phone/Fax

Practice location:
  • Phone: 760-737-7125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95466210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: