Provider Demographics
NPI:1326209123
Name:FLADOOS, SHIRLEY KIM (MPAP, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KIM
Last Name:FLADOOS
Suffix:
Gender:F
Credentials:MPAP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 6TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3934
Mailing Address - Country:US
Mailing Address - Phone:310-883-4226
Mailing Address - Fax:
Practice Address - Street 1:1033 6TH ST APT 302
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3934
Practice Address - Country:US
Practice Address - Phone:310-883-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19781363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical