Provider Demographics
NPI:1104264217
Name:SHWAISH, NATALIE SUE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:SUE
Last Name:SHWAISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:SUE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4200
Mailing Address - Fax:909-558-4207
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4200
Practice Address - Fax:909-558-4207
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA175323208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics