Provider Demographics
NPI:1134420144
Name:SHAFII NOORI, SHILA
Entity type:Individual
Prefix:
First Name:SHILA
Middle Name:
Last Name:SHAFII NOORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S ZEDIKER AVE
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2666
Mailing Address - Country:US
Mailing Address - Phone:800-492-4227
Mailing Address - Fax:
Practice Address - Street 1:121 BARBOZA ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-1901
Practice Address - Country:US
Practice Address - Phone:559-655-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA118489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134420144Medicaid