Healthcare Provider Details

I. General information

NPI: 1457043424
Provider Name (Legal Business Name): WIDAD SHALABI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

V. Phone/Fax

Practice location:
  • Phone: 213-743-7300
  • Fax: 213-741-1423
Mailing address:
  • Phone: 213-743-7300
  • Fax: 213-741-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: