Provider Demographics
NPI:1740228469
Name:SHAFI KHALID MD PC
Entity Type:Organization
Organization Name:SHAFI KHALID MD PC
Other - Org Name:SAN DIEGO PAIN CONSULTANTS,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-485-7246
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-485-7246
Mailing Address - Fax:858-485-8676
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-485-7246
Practice Address - Fax:858-485-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51093207RG0300X, 2084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740228469Medicaid
CA1750343760Medicaid