Provider Demographics
NPI:1518645795
Name:SHAHIDA K SYED ENTERPRISES LLC
Entity Type:Organization
Organization Name:SHAHIDA K SYED ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-393-0191
Mailing Address - Street 1:19660 ARCADIA ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 GREEN RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-2306
Practice Address - Country:US
Practice Address - Phone:951-393-0191
Practice Address - Fax:951-987-0042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHIDA K SYED ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330179EPOtherDEPARTMENT OF HEALTH CARE SERVICES