Provider Demographics
NPI:1972072999
Name:SAULENA SHAFER D.O., INC.
Entity type:Organization
Organization Name:SAULENA SHAFER D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAULENA
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-203-1823
Mailing Address - Street 1:3235 GRAND CANAL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1707
Mailing Address - Country:US
Mailing Address - Phone:951-203-1823
Mailing Address - Fax:
Practice Address - Street 1:510 SUPERIOR AVE STE 200A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3664
Practice Address - Country:US
Practice Address - Phone:951-203-1823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty