Provider Demographics
NPI:1942003991
Name:TA COMMUNITY MEDICAL CLINIC
Entity type:Organization
Organization Name:TA COMMUNITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-330-7402
Mailing Address - Street 1:4263 TIERRA REJADA RD # 188
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3772
Mailing Address - Country:US
Mailing Address - Phone:619-330-7402
Mailing Address - Fax:619-330-5494
Practice Address - Street 1:502 EUCLID AVE STE 302
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2995
Practice Address - Country:US
Practice Address - Phone:619-330-7402
Practice Address - Fax:619-330-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care