Provider Demographics
NPI:1417560863
Name:HABIB M.D. INC.
Entity Type:Organization
Organization Name:HABIB M.D. INC.
Other - Org Name:PRIME FAMILY AND WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
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:626-446-4659
Mailing Address - Street 1:509 W DUARTE RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7334
Mailing Address - Country:US
Mailing Address - Phone:408-205-6572
Mailing Address - Fax:
Practice Address - Street 1:612 W DUARTE RD STE 801
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9248
Practice Address - Country:US
Practice Address - Phone:626-446-4659
Practice Address - Fax:626-446-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215039631Medicaid