Provider Demographics
NPI:1871798009
Name:SHAKIR, HALA Z
Entity type:Individual
Prefix:DR
First Name:HALA
Middle Name:Z
Last Name:SHAKIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10804 RISING SMOKE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4677
Mailing Address - Country:US
Mailing Address - Phone:714-480-3000
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:69160 RAMON ROAD
Practice Address - Street 2:STUITE #100
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3343
Practice Address - Country:US
Practice Address - Phone:760-969-5469
Practice Address - Fax:760-770-0280
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55755Medicaid