Healthcare Provider Details

I. General information

NPI: 1215850896
Provider Name (Legal Business Name): MS. HIBA SHAHAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 PACIFIC AVE
STOCKTON CA
95211-0110
US

IV. Provider business mailing address

322 MISTY CIR
LIVERMORE CA
94550-2520
US

V. Phone/Fax

Practice location:
  • Phone: 209-946-2285
  • Fax:
Mailing address:
  • Phone: 510-240-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: