Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A63071 | CA |
NPI | 1114997434 |
---|---|
Provider Name | Dr. Raymond Michael Shaheen I |
First Address | Mountain View, CA 94040-4200 |
Second Address | Mountain View, CA 94040-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G88764 | (02) | CA |