Provider Demographics
NPI:1063574267
Name:QAZI, SHAGUFTA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAGUFTA
Middle Name:
Last Name:QAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 LOMITA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1636
Mailing Address - Country:US
Mailing Address - Phone:424-305-4169
Mailing Address - Fax:310-791-7409
Practice Address - Street 1:2173 LOMITA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1636
Practice Address - Country:US
Practice Address - Phone:424-305-4169
Practice Address - Fax:310-791-7409
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics