MEDICARE: VALENTINA R DALILI-SHOAIE 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	207SG0201X	Clinical Genetics (M.D.) Physician	A103357	CA
2	207R00000X	Internal Medicine Physician	A103357	CA

General Provider Information

NPI Number	:	1447224126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENTINA R DALILI-SHOAIE MD

Provider Business Mailing Address
First Line	:	510 SUPERIOR AVE
Second Line	:	STE 200B
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3663
Country	:	US
Telephone Number	:	949-791-3001
Fax Number	:	949-791-3096

Provider Business Practice Location Address
First Line	:	510 SUPERIOR AVE
Second Line	:	STE 200B
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3663
Country	:	US
Telephone Number	:	949-791-3001
Fax Number	:	949-791-3096

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/03/2019

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