Healthcare Provider Details

I. General information

NPI: 1518846385
Provider Name (Legal Business Name): SHIFA REGENERATIVE CENTER AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA STE 24A
LAGUNA HILLS CA
92653-4343
US

IV. Provider business mailing address

2012 FALLEN LEAF PL
TUSTIN CA
92780-6713
US

V. Phone/Fax

Practice location:
  • Phone: 714-875-3755
  • Fax: 714-875-3755
Mailing address:
  • Phone: 714-875-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PROF. AMJAD AL-KHAWALDEH
Title or Position: OWNER/CEO
Credential: PHD, CNS, NP
Phone: 714-875-3755