Provider Demographics
NPI:1316145550
Name:LINA SHUHAIBAR MD, INC. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LINA SHUHAIBAR MD, INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUHAIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-905-6178
Mailing Address - Street 1:2694 E GARVEY AVE S
Mailing Address - Street 2:22
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2113
Mailing Address - Country:US
Mailing Address - Phone:626-905-6178
Mailing Address - Fax:
Practice Address - Street 1:1041 W BADILLO ST
Practice Address - Street 2:103
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4194
Practice Address - Country:US
Practice Address - Phone:626-339-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53782261QM0801X, 261QM0855X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health