Provider Demographics
NPI:1932491842
Name:SHABAFROOZ, SHARAREH (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARAREH
Middle Name:
Last Name:SHABAFROOZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3646
Mailing Address - Country:US
Mailing Address - Phone:323-326-1611
Mailing Address - Fax:
Practice Address - Street 1:6901 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-3646
Practice Address - Country:US
Practice Address - Phone:323-326-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine