Provider Demographics
NPI:1003963612
Name:HASHEMI, SHAHLA (PAC)
Entity Type:Individual
Prefix:
First Name:SHAHLA
Middle Name:
Last Name:HASHEMI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-0047
Mailing Address - Country:US
Mailing Address - Phone:562-531-2231
Mailing Address - Fax:562-531-8845
Practice Address - Street 1:15955 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5113
Practice Address - Country:US
Practice Address - Phone:562-531-2231
Practice Address - Fax:562-531-8845
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant