Provider Demographics
NPI:1780975839
Name:HADIDCHI, SHIMA (MD)
Entity type:Individual
Prefix:DR
First Name:SHIMA
Middle Name:
Last Name:HADIDCHI
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 1:12740 HESPERIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8306
Mailing Address - Country:US
Mailing Address - Phone:805-698-4411
Mailing Address - Fax:
Practice Address - Street 1:12740 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8306
Practice Address - Country:US
Practice Address - Phone:760-998-1999
Practice Address - Fax:760-881-3555
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine