Healthcare Provider Details

I. General information

NPI: 1235042268
Provider Name (Legal Business Name): NADINE SHAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST STE A-D
ORANGE CA
92868-2869
US

IV. Provider business mailing address

18750 DELAWARE ST UNIT 383
HUNTINGTON BEACH CA
92648-9422
US

V. Phone/Fax

Practice location:
  • Phone: 657-218-5865
  • Fax:
Mailing address:
  • Phone: 213-561-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: