MEDICARE: SHAUNAK MARU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	PT296055	CA

General Provider Information

NPI Number	:	1811469240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNAK MARU

Provider Business Mailing Address
First Line	:	1751 LIBERTY ST APT 302
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-1975
Country	:	US
Telephone Number	:	510-375-8158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 LIBERTY ST APT 302
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-1975
Country	:	US
Telephone Number	:	510-375-8158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2018
Last Update Date	:	02/11/2022

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Directions to “ SHAUNAK MARU ” Practice Location

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