Healthcare Provider Details

I. General information

NPI: 1598882078
Provider Name (Legal Business Name): TOURAJ SHAFAI, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 MAGNOLIA AVE STE A
RIVERSIDE CA
92504
US

IV. Provider business mailing address

7101 MAGNOLIA AVE STE A
RIVERSIDE CA
92504
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-9780
  • Fax: 951-682-9787
Mailing address:
  • Phone: 951-682-9780
  • Fax: 951-682-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA25031
License Number StateCA

VIII. Authorized Official

Name: DR. TOURAJ SHAFAI
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 951-682-9780