Provider Demographics
NPI:1568017788
Name:SHABAK, MARAL (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MARAL
Middle Name:
Last Name:SHABAK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 SWEETBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6906
Mailing Address - Country:US
Mailing Address - Phone:714-585-6197
Mailing Address - Fax:951-200-4396
Practice Address - Street 1:577 E ELDER ST STE H
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-645-3447
Practice Address - Fax:951-200-4396
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM585176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife