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General NPI Number Information
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NPI Number | 1225378060
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Entity Type | Individual
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Provider Name | BRETT BOBAK SHAHABI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 5 CENTERPOINTE DR
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City | LA PALMA
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State | CA
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Zip | 90623-1050
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Country | US
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Telephone | 888-988-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 EUREKA RD
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City | ROSEVILLE
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State | CA
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Zip | 95661-3027
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Country | US
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Telephone | 510-625-2856
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Fax | 877-738-4262
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5201
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License Number State | CA
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