1073599254 NPI number — DR. SHADI AMINOLOLAMA-SHAKERI M.D.

Table of content: DR. SHADI AMINOLOLAMA-SHAKERI M.D. (NPI 1073599254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073599254 NPI number — DR. SHADI AMINOLOLAMA-SHAKERI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMINOLOLAMA-SHAKERI
Provider First Name:
SHADI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073599254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 SAXTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-377-8341
Provider Business Mailing Address Fax Number:
916-734-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4860 Y ST
Provider Second Line Business Practice Location Address:
SUITE 3100
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5195
Provider Business Practice Location Address Fax Number:
916-734-6548
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2471C3402X , with the licence number:  A80023 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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