Individual
ABDUL SHUKOOR ENAYAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12550 HESPERIA RD STE 100, VICTORVILLE, CA 92395-5873
(760) 241-6666
(760) 947-5619
Mailing address
200 W CENTER STREET PROMENADE STE 400, ANAHEIM, CA 92805-3960
(714) 449-4800
(714) 449-4956
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C150664
CA
207R00000X
Internal Medicine Physician
MC16944
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D0984814
CLIA
TN
01
—
P00614804
RAILROAD MEDICARE PTAN
TN
Enumeration date
06/10/2006
Last updated
07/21/2022
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