Provider Demographics
NPI:1619014115
Name:SHEHAB SADDY
Entity Type:Organization
Organization Name:SHEHAB SADDY
Other - Org Name:GERIATRIC MEDICAL CENTER OF MONTEREY PENIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SADDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-642-9800
Mailing Address - Street 1:2 UPPER RAGSDALE DR
Mailing Address - Street 2:SUITE B 240
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5736
Mailing Address - Country:US
Mailing Address - Phone:831-642-9800
Mailing Address - Fax:831-642-9700
Practice Address - Street 1:2 UPPER RAGSDALE DR
Practice Address - Street 2:SUITE B240
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-642-9800
Practice Address - Fax:831-642-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68347207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23972ZMedicare PIN