Individual
SHAHAB MOMTAZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 W WILLOW, # 305, VISALIA, CA 93291
(559) 732-0762
(559) 627-5192
Mailing address
PO BOX 4199, VISALIA, CA 93278
(559) 627-6363
(559) 627-3627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G68758
CA
207RP1001X
Pulmonary Disease Physician
Primary
G68758
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G687580
—
CA
Enumeration date
11/21/2006
Last updated
01/27/2010
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