Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 048447 | CT |
N | 207V00000X | Obstetrician & Gynecologist | 239820 | NY |
Y | 207V00000X | Obstetrician & Gynecologist | C55816 | CA |
N | 207VX0000X | Obstetrician | 25MA08177000 | NJ |
NPI | 1083636450 |
---|---|
Provider Name | Dr. Shazah Khawaja |
First Address | Santa Rosa, CA 95405-4558 |
Second Address | Santa Rosa, CA 95405-4558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048447 | LICENSE (01) | CT |
239820 | LICENSE (01) | NY |
25MA08177000 | LICENSE (01) | NJ |
BK9734484 | DEA (01) | NY |
D09013100 | CDS (01) | NJ |
FK2572229 | DEA (01) | NJ |
I74121 | (02) | NJ |