MEDICARE: SHEILA BAZZAZ M.D.

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	207W00000X	Ophthalmology Physician	MD429029	PA
2	207W00000X	Ophthalmology Physician	A84773	CA

General Provider Information

NPI Number	:	1831140953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA BAZZAZ M.D.

Provider Business Mailing Address
First Line	:	3401 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7933
Country	:	US
Telephone Number	:	714-427-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7933
Country	:	US
Telephone Number	:	714-427-7833
Fax Number	:

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	11/30/2021

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