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General NPI Number Information
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NPI Number | 1922100320
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Entity Type | Individual
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Provider Name | NAEL M SHAHATTO MD
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 399 E HIGHLAND AVE STE 309
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-883-9953
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Fax | 909-883-2840
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Provider Business Mailing Address
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Address Line | 22421 BARTON RD # 296
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5008
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Country | US
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Telephone | 909-883-9953
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Fax | 909-883-2840
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | A52423
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License Number State | CA
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