=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598882078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOURAJ SHAFAI, M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 03/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7101 MAGNOLIA AVE STE A
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-682-9780
-----------------------------------------------------
Fax | 951-682-9787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7101 MAGNOLIA AVE STE A
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-682-9780
-----------------------------------------------------
Fax | 951-682-9787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TOURAJ SHAFAI
-----------------------------------------------------
Credential | M.D., PH.D.
-----------------------------------------------------
Telephone | 951-682-9780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | A25031
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------