MEDICARE: SHATHA BAKIR MD

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
1	207Q00000X	Family Medicine Physician	A49522	CA

General Provider Information

NPI Number	:	1356309504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATHA BAKIR MD

Provider Business Mailing Address
First Line	:	12550 HESPERIA RD
Second Line	:	SUITE 100
City	:	VICTORVILLE
State	:	CA
Zip	:	92395-5873
Country	:	US
Telephone Number	:	760-241-6666
Fax Number	:	760-241-7575

Provider Business Practice Location Address
First Line	:	19333 BEAR VALLEY RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5148
Country	:	US
Telephone Number	:	760-240-3784
Fax Number	:	760-247-4368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/29/2015

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