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General NPI Number Information
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NPI Number | 1326209123
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Entity Type | Individual
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Provider Name | SHIRLEY KIM FLADOOS MPAP, PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 10/24/2021
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Provider Practice Location Address
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Address Line | 1033 6TH ST APT 302
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City | SANTA MONICA
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State | CA
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Zip | 90403-3934
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Country | US
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Telephone | 310-883-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 6TH ST APT 302
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City | SANTA MONICA
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State | CA
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Zip | 90403-3934
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Country | US
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Telephone | 310-883-4226
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19781
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA19781
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19781
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License Number State | CA
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