Healthcare Provider Details

I. General information

NPI: 1831873918
Provider Name (Legal Business Name): HAKEEM SHOOLA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 362
ORANGE CA
92868-2972
US

IV. Provider business mailing address

333 CITY BLVD W STE 362
ORANGE CA
92868-2972
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-4455
  • Fax:
Mailing address:
  • Phone: 615-673-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: