Basic Information
| Provider Information | |||||||||
| NPI: | 1801414776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK SHAFA MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25033 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927995033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143471000 | ||||||||
| FaxNumber: | 7146471245 | ||||||||
| Practice Location | |||||||||
| Address1: | 8670 WILSHIRE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102751646 | ||||||||
| FaxNumber: | 3102754294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHAFA | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7143471000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.