Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 960327 | CA |
NPI | 1215085477 |
---|---|
Provider Name | Dr. Shadi Amin |
First Address | Santa Ana, CA 92704-7300 |
Second Address | Santa Ana, CA 92704-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |