Provider Demographics
NPI:1952476004
Name:SHAAF, MEHDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:SHAAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40055 BOB HOPE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3937
Mailing Address - Country:US
Mailing Address - Phone:760-346-5005
Mailing Address - Fax:760-346-6446
Practice Address - Street 1:40055 BOB HOPE DR
Practice Address - Street 2:SUITE J
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3937
Practice Address - Country:US
Practice Address - Phone:760-346-5005
Practice Address - Fax:760-346-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86815207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G868150Medicaid
CA00G868150Medicaid