Provider Demographics
NPI:1780168617
Name:VALENTINA DALILI-SHOAIE, M.D., INC.
Entity type:Organization
Organization Name:VALENTINA DALILI-SHOAIE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DALILI-SHOAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-328-1065
Mailing Address - Street 1:15642 SANDCANYON AVE
Mailing Address - Street 2:PO BOX 53966
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619
Mailing Address - Country:US
Mailing Address - Phone:714-328-1065
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR BLDG 41
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-791-6340
Practice Address - Fax:949-764-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty