Provider Demographics
NPI:1588612774
Name:SHAKIBAI, NEEMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEEMA
Middle Name:
Last Name:SHAKIBAI
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 1:5525 GROSSMONT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3014
Mailing Address - Country:US
Mailing Address - Phone:858-499-2711
Mailing Address - Fax:619-644-6809
Practice Address - Street 1:5525 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:858-499-2711
Practice Address - Fax:619-644-6809
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230583207R00000X
CAC152587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine