Provider Demographics
NPI:1659350510
Name:MOHTASHAM SHALIKAR
Entity Type:Organization
Organization Name:MOHTASHAM SHALIKAR
Other - Org Name:DISCOUNT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHTASHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF ART IN POP
Authorized Official - Phone:951-343-1082
Mailing Address - Street 1:6570 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2410
Mailing Address - Country:US
Mailing Address - Phone:951-343-1082
Mailing Address - Fax:951-343-1363
Practice Address - Street 1:6570 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2410
Practice Address - Country:US
Practice Address - Phone:951-343-1082
Practice Address - Fax:951-343-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100945332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02100FMedicaid
1033250001Medicare NSC