Provider Demographics
NPI:1699138677
Name:SHAHIN ETEBAR MD INC
Entity type:Organization
Organization Name:SHAHIN ETEBAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ETEBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-8058
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1053
Mailing Address - Country:US
Mailing Address - Phone:760-346-8058
Mailing Address - Fax:417-890-9127
Practice Address - Street 1:36101 BOB HOPE DR STE B2
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2003
Practice Address - Country:US
Practice Address - Phone:760-346-8058
Practice Address - Fax:417-890-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty