Healthcare Provider Details

I. General information

NPI: 1629450952
Provider Name (Legal Business Name): SAHIL SHAH CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 STOCKDALE HWY UNIT C
BAKERSFIELD CA
93311-3626
US

IV. Provider business mailing address

11307 CRABBET PARK DR
BAKERSFIELD CA
93311-9227
US

V. Phone/Fax

Practice location:
  • Phone: 661-717-4750
  • Fax:
Mailing address:
  • Phone: 661-717-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: