Provider Demographics
NPI:1801555073
Name:SHAHBA, REZA (DC)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:SHAHBA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KATELLA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3491
Mailing Address - Country:US
Mailing Address - Phone:424-634-9373
Mailing Address - Fax:562-795-6630
Practice Address - Street 1:4132 KATELLA AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3491
Practice Address - Country:US
Practice Address - Phone:562-596-9677
Practice Address - Fax:562-795-6630
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36204111N00000X
CADC36204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor