Provider Demographics
NPI:1376170100
Name:GIURGIUS, SHADEE MOATAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADEE
Middle Name:MOATAZ
Last Name:GIURGIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20409 YORBA LINDA BLVD SUITE K2-265
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3042
Mailing Address - Country:US
Mailing Address - Phone:562-947-8832
Mailing Address - Fax:562-947-8839
Practice Address - Street 1:20409 YORBA LINDA BLVD SUITE K2-265
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3042
Practice Address - Country:US
Practice Address - Phone:562-947-8832
Practice Address - Fax:562-947-8839
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program