Healthcare Provider Details

I. General information

NPI: 1851435424
Provider Name (Legal Business Name): SHADMAN HABIBI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OB-GYN CONSULTATION 200 UCLA MEDICAL PLAZA, SUITE 430
LOS ANGELES CA
90095-6928
US

IV. Provider business mailing address

430 OB-GYN CONSULTATION 200 UCLA MEDICAL PLAZA, SUITE 430
LOS ANGELES CA
90095-6928
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7274
  • Fax: 310-794-7236
Mailing address:
  • Phone: 310-794-7274
  • Fax: 310-794-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: