Provider Demographics
NPI:1487124640
Name:SHAHIN, ADRIANA MORALES
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MORALES
Last Name:SHAHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:JOSEFINA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:22002 SUNRISE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5752
Mailing Address - Country:US
Mailing Address - Phone:510-869-6511
Mailing Address - Fax:
Practice Address - Street 1:8781 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2401
Practice Address - Country:US
Practice Address - Phone:818-903-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56596363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical