Healthcare Provider Details

I. General information

NPI: 1184658130
Provider Name (Legal Business Name): NOUSHIN SHOAEE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4765 CARMEL MOUNTAIN RD SUITE 104
SAN DIEGO CA
92130-6657
US

IV. Provider business mailing address

4765 CARMEL MOUNTAIN RD SUITE 104
SAN DIEGO CA
92130-6657
US

V. Phone/Fax

Practice location:
  • Phone: 858-481-8240
  • Fax:
Mailing address:
  • Phone: 858-481-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: