Healthcare Provider Details

I. General information

NPI: 1275586992
Provider Name (Legal Business Name): REZA SHAFEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E 1ST ST SUITE 130
SANTA ANA CA
92705-4079
US

IV. Provider business mailing address

1400 N MAIN ST
SANTA ANA CA
92701-2321
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2287
  • Fax:
Mailing address:
  • Phone: 714-352-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85480
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA85480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: