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General NPI Number Information
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NPI Number | 1154530160
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Entity Type | Individual
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Provider Name | ELIZA S. AZAD SHAFA RDH
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8853 W OLYMPIC BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3605
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Country | US
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Telephone | 310-600-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 S BEVERLY GLEN BLVD #407
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City | LOS ANGELES
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State | CA
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Zip | 90024-5214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 17638
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License Number State | CA
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