Healthcare Provider Details

I. General information

NPI: 1487944062
Provider Name (Legal Business Name): SHABNAM KHASHABI TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 CAMPUS POINT DR
LA JOLLA CA
92093-1350
US

IV. Provider business mailing address

5350 TOSCANA WAY # E315
SAN DIEGO CA
92122-5672
US

V. Phone/Fax

Practice location:
  • Phone: 858-855-1569
  • Fax:
Mailing address:
  • Phone: 530-417-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: