Provider Demographics
NPI:1851572952
Name:SHALIKAR, MOHTASHAM
Entity Type:Individual
Prefix:
First Name:MOHTASHAM
Middle Name:
Last Name:SHALIKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DISCOUNT MEDICAL
Other - Middle Name:
Other - Last Name:(DBA)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10403 MAGNOLIA AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1909
Mailing Address - Country:US
Mailing Address - Phone:951-343-1082
Mailing Address - Fax:
Practice Address - Street 1:10403 MAGNOLIA AVE
Practice Address - Street 2:STE. A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1909
Practice Address - Country:US
Practice Address - Phone:951-343-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2016-08-25
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
CA1033250001Medicare NSC