Provider Demographics
NPI:1346569217
Name:SHEHNAZ N. HABIB, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHEHNAZ N. HABIB, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SHEHNAZ
Authorized Official - Middle Name:N
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-782-0604
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-782-0604
Mailing Address - Fax:818-989-0780
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-782-0604
Practice Address - Fax:818-989-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50211207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502110Medicaid
CA00A502110Medicaid
CAF75233Medicare UPIN