Provider Demographics
NPI:1356933683
Name:SHAHBAZI, NASIM (MD)
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:SHAHBAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:2205 ROSS AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3623
Practice Address - Country:US
Practice Address - Phone:760-353-0404
Practice Address - Fax:760-353-0392
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168647207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology