Provider Demographics
NPI:1699802223
Name:SHAMIM, FATEMA ARIF (MD)
Entity type:Individual
Prefix:MRS
First Name:FATEMA
Middle Name:ARIF
Last Name:SHAMIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 W. MANCHESTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2436
Mailing Address - Country:US
Mailing Address - Phone:323-778-4310
Mailing Address - Fax:323-778-0838
Practice Address - Street 1:2710 W. MANCHESTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2436
Practice Address - Country:US
Practice Address - Phone:323-778-4310
Practice Address - Fax:323-778-0838
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87291208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A872910Medicaid