Provider Demographics
NPI:1306903208
Name:RAD, SHAHLA Y (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:Y
Last Name:RAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18059
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-4059
Mailing Address - Country:US
Mailing Address - Phone:818-652-6130
Mailing Address - Fax:310-276-2778
Practice Address - Street 1:8642W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2301
Practice Address - Country:US
Practice Address - Phone:310-289-1114
Practice Address - Fax:310-289-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine