Provider Demographics
NPI:1043494313
Name:SHAKHBAZOVA, MILENA (MD)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:SHAKHBAZOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 SKYPARK DR
Mailing Address - Street 2:STE.100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5023
Mailing Address - Country:US
Mailing Address - Phone:310-784-6300
Mailing Address - Fax:310-784-6313
Practice Address - Street 1:3333 SKYPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5023
Practice Address - Country:US
Practice Address - Phone:310-784-6300
Practice Address - Fax:310-784-6313
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC09454ZMedicare PIN