Healthcare Provider Details

I. General information

NPI: 1568800761
Provider Name (Legal Business Name): SHOBHA NAIMPALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A-9
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

5850 S MAIN ST
LOS ANGELES CA
90003-1215
US

V. Phone/Fax

Practice location:
  • Phone: 626-299-3365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA30975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: