Doctor Name: | DR. BRETT BOBAK SHAHABI |
NPI Number: | 1225378060 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | E5201 |
Business Practice Address: | 5 Centerpointe Dr La Palma, CA - 906231050 |
Business Phone Number: | 8889882800 |
Business Fax Number: | |
Mailing Address: | 5 Centerpointe Dr, LA PALMA |
State: | CA |
Postal Code: | 906231050 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/14/2013 |
NPI Last Update Date: | 09/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | E5201 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |