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General NPI Number Information
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NPI Number | 1861321150
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Entity Type | Organization
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Legal Business Name | DE VIDA MEDICAL CLINIC INC A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 3710 E CESAR E CHAVEZ AVE FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90063-2219
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Country | US
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Telephone | 323-406-2029
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Fax | 323-406-2042
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Provider Business Mailing Address
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Address Line | 3710 E CESAR E CHAVEZ AVE FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90063-2219
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Country | US
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Telephone | 323-406-2029
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Fax | 323-406-2042
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Authorized Official
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Title or Position | PRESIDENT
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Name | EFREN SHAHABEDDIN
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Credential | MD
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Telephone | 818-482-9967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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