Healthcare Provider Details

I. General information

NPI: 1215381959
Provider Name (Legal Business Name): NIRVI SHAH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 12/03/2021
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 CALIFORNIA AVE STE 300
BAKERSFIELD CA
93309-0712
US

IV. Provider business mailing address

5055 CALIFORNIA AVE STE 300
BAKERSFIELD CA
93309-0712
US

V. Phone/Fax

Practice location:
  • Phone: 661-334-2009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number20A16221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: