Provider Demographics
NPI:1720063464
Name:SHBEEB, IMAD A (MD)
Entity Type:Individual
Prefix:
First Name:IMAD
Middle Name:A
Last Name:SHBEEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 CHERRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2445
Mailing Address - Country:US
Mailing Address - Phone:562-596-7700
Mailing Address - Fax:562-596-7600
Practice Address - Street 1:10931 CHERRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2445
Practice Address - Country:US
Practice Address - Phone:562-596-7700
Practice Address - Fax:562-596-7600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38275208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03138Medicare UPIN
CAN16034Medicare ID - Type Unspecified