Healthcare Provider Details

I. General information

NPI: 1881435261
Provider Name (Legal Business Name): INGI SHENOUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST STE 100
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

27630 SOLANA WAY
SANTA CLARITA CA
91350-5778
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-4224
  • Fax:
Mailing address:
  • Phone: 818-903-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: