Healthcare Provider Details

I. General information

NPI: 1912083924
Provider Name (Legal Business Name): SHOKOOR ABRAHIM P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3484 E. FIRST ST.
LOS ANGELES CA
90063-2946
US

IV. Provider business mailing address

1840 BRIDGEGATE ST STE 1
WESTLAKE VILLAGE CA
91361-1466
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-4436
  • Fax:
Mailing address:
  • Phone: 805-497-7811
  • Fax: 818-879-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: