Healthcare Provider Details

I. General information

NPI: 1376170100
Provider Name (Legal Business Name): SHADEE MOATAZ GIURGIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20409 YORBA LINDA BLVD SUITE K2-265
YORBA LINDA CA
92886-3042
US

IV. Provider business mailing address

20409 YORBA LINDA BLVD STE K2-265
YORBA LINDA CA
92886-3042
US

V. Phone/Fax

Practice location:
  • Phone: 562-450-0425
  • Fax: 562-947-8839
Mailing address:
  • Phone: 562-450-0425
  • Fax: 562-947-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA179744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: