Provider Demographics
NPI:1609100924
Name:SIMA SHAKIBA, M.D. INC.
Entity Type:Organization
Organization Name:SIMA SHAKIBA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-232-9862
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1223
Mailing Address - Country:US
Mailing Address - Phone:858-232-9862
Mailing Address - Fax:
Practice Address - Street 1:535 ENCINITAS BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3742
Practice Address - Country:US
Practice Address - Phone:858-232-9862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51469261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center