Provider Demographics
NPI:1295132298
Name:TAHSEEN SHAREEF MD, INC
Entity type:Organization
Organization Name:TAHSEEN SHAREEF MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHSEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-203-3825
Mailing Address - Street 1:11374 MOUNTAIN VIEW AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3830
Mailing Address - Country:US
Mailing Address - Phone:909-203-3825
Mailing Address - Fax:909-799-3888
Practice Address - Street 1:11374 MOUNTAIN VIEW AVE STE A1
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3830
Practice Address - Country:US
Practice Address - Phone:909-203-3825
Practice Address - Fax:909-799-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G841090Medicaid
CADJ334AMedicare PIN
CAG66759Medicare UPIN