Provider Demographics
NPI:1831653781
Name:DR. MIMI SHAGAGA INC.
Entity Type:Organization
Organization Name:DR. MIMI SHAGAGA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-274-2963
Mailing Address - Street 1:13351D RIVERSIDE DR STE 598
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2508
Mailing Address - Country:US
Mailing Address - Phone:424-274-2963
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD STE 315
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0903
Practice Address - Country:US
Practice Address - Phone:424-274-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health