Healthcare Provider Details

I. General information

NPI: 1790966018
Provider Name (Legal Business Name): MAJID SHAHBAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR SUITE 408
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR SUITE 408
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-1174
  • Fax: 619-583-4609
Mailing address:
  • Phone: 619-583-1174
  • Fax: 619-583-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA50402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: