Provider Demographics
NPI:1659476331
Name:NAWAZ, SHAJITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAJITHA
Middle Name:
Last Name:NAWAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40925 COUNTY CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6037
Mailing Address - Country:US
Mailing Address - Phone:951-600-6300
Mailing Address - Fax:
Practice Address - Street 1:40925 COUNTY CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6037
Practice Address - Country:US
Practice Address - Phone:951-600-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030317762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO538386OtherVALUE OPTIONS
MO209043603Medicaid
MO191269OtherBLUE CROSS BLUE SHIELD
MO209043603Medicaid
MOIO5694Medicare UPIN