Active NPI
Shabnam Mahmood Moledina, N.P.
- Nurse Practitioner
- La Verne, CA
National Provider Identifier
1619212081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 21922
- Practice address
- 1502 Arrow Hwy
La Verne, CA 91750-5318 - Phone
- (909) 593-4333
- Fax
- (909) 593-5588
- NPI assigned
- Dec 11, 2012
- Last updated
- Dec 11, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 21922 | CA | Primary |
Addresses
Primary practice location
1502 Arrow Hwy
La Verne, CA 91750-5318
Mailing address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (951) 486-5764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21922 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355184000000",
"number": "1619212081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26520 CACTUS AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925553927",
"telephone_number": "951-486-5764",
"fax_number": "951-486-5749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1502 ARROW HWY",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917505318",
"telephone_number": "909-593-4333",
"fax_number": "909-593-5588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLEDINA",
"first_name": "SHABNAM",
"middle_name": "MAHMOOD",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-11",
"last_updated": "2012-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "21922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.