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General NPI Number Information
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NPI Number | 1619212081
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Entity Type | Individual
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Provider Name | SHABNAM MAHMOOD MOLEDINA N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 1502 ARROW HWY
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City | LA VERNE
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State | CA
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Zip | 91750-5318
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Country | US
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Telephone | 909-593-4333
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Fax | 909-593-5588
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Provider Business Mailing Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-5764
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Fax | 951-486-5749
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 21922
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License Number State | CA
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