Provider Demographics
NPI:1619372513
Name:MASHHADI, SHAMIM
Entity Type:Individual
Prefix:
First Name:SHAMIM
Middle Name:
Last Name:MASHHADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 CARTER AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4958
Mailing Address - Country:US
Mailing Address - Phone:310-658-6426
Mailing Address - Fax:
Practice Address - Street 1:3221 CARTER AVE UNIT 303
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4958
Practice Address - Country:US
Practice Address - Phone:310-658-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor