=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346602315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. MUHAMMAD TAJUDDIN SHUAIB
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2016
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23929 MCBEAN PKWY STE 216
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-4468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-782-5041
-----------------------------------------------------
Fax | 213-204-3794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23929 MCBEAN PKWY STE 216
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-4468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-378-7023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A153532
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------