Provider Demographics
NPI:1972825305
Name:SAN ANTONIO MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:SAN ANTONIO MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IHSAN
Authorized Official - Middle Name:NAJIB
Authorized Official - Last Name:SHAMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-541-4090
Mailing Address - Street 1:P.O. BOX 6098
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706
Mailing Address - Country:US
Mailing Address - Phone:714-541-4090
Mailing Address - Fax:714-541-8815
Practice Address - Street 1:610 W. 17TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706
Practice Address - Country:US
Practice Address - Phone:714-541-4090
Practice Address - Fax:714-541-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty