Provider Demographics
NPI:1154139319
Name:SHAHBAZIAN, EMITA
Entity type:Individual
Prefix:
First Name:EMITA
Middle Name:
Last Name:SHAHBAZIAN
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 1:1633 VASCONCELLOS WAY
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7436
Mailing Address - Country:US
Mailing Address - Phone:209-450-9090
Mailing Address - Fax:
Practice Address - Street 1:4701 STODDARD RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9818
Practice Address - Country:US
Practice Address - Phone:209-558-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95253334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse