Provider Demographics
NPI:1306962550
Name:SHALHUB, WADAD J
Entity type:Individual
Prefix:
First Name:WADAD
Middle Name:J
Last Name:SHALHUB
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 1:2100 W 3RD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1999
Mailing Address - Country:US
Mailing Address - Phone:213-483-9930
Mailing Address - Fax:213-989-7473
Practice Address - Street 1:2100 W 3RD ST STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1999
Practice Address - Country:US
Practice Address - Phone:213-483-9930
Practice Address - Fax:213-989-7473
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1798237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter