| Shima Hadidchi Md A Professional Corp | |
|
12740 Hesperia Rd Ste A Victorville CA 92395-8306 | |
| (760) 998-1999 | |
| (760) 881-3555 |
| Full Name | Shima Hadidchi Md A Professional Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 12740 Hesperia Rd Ste A, Victorville, California |
| Authorized Official Name and Position | Shima Hadidchi (OWNER) |
| Authorized Official Contact | 7609981999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shima Hadidchi Md A Professional Corp 12740 Hesperia Rd Ste B Victorville CA 92395-8306 Ph: (760) 245-6106 | Shima Hadidchi Md A Professional Corp 12740 Hesperia Rd Ste A Victorville CA 92395-8306 Ph: (760) 998-1999 |
| NPI Number | 1225685332 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 02/29/2020 |
| Medicare PECOS PAC ID | 5991137911 |
|---|---|
| Medicare Enrollment ID | O20191113001910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225685332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shima Hadidchi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780975839 PECOS PAC ID: 2668620287 Enrollment ID: I20120924000321 |
| Provider Name | Justin Atkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477191062 PECOS PAC ID: 0840628467 Enrollment ID: I20200313001771 |
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