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NPI Code Detail

MEDICARE: DR. SHAHAB MAHBOUBIAN D.O.

MEDICARE: DR. SHAHAB MAHBOUBIAN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician20A10721CA
2207X00000XOrthopaedic Surgery Physician248035NY

General Provider Information

NPI Number : 1144439316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAHAB MAHBOUBIAN D.O.
Provider Business Mailing Address
First Line : PO BOX 261666
Second Line :
City : ENCINO
State : CA
Zip : 91426-1666
Country : US
Telephone Number : 818-322-0126
Fax Number : 818-755-8904
Provider Business Practice Location Address
First Line : 10640 RIVERSIDE DRIVE
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91602-2319
Country : US
Telephone Number : 818-755-6500
Fax Number : 818-755-8904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 05/02/2012

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