Provider Demographics
NPI:1417256074
Name:ZARGAR, SHABNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABNAM
Middle Name:
Last Name:ZARGAR
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 1:2040 W CHARLESTON BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2227
Mailing Address - Country:US
Mailing Address - Phone:702-671-2236
Mailing Address - Fax:702-671-2333
Practice Address - Street 1:769 MEDICAL CENTER CT STE 300
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6602
Practice Address - Country:US
Practice Address - Phone:619-482-3090
Practice Address - Fax:619-482-7350
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty