Healthcare Provider Details

I. General information

NPI: 1568429678
Provider Name (Legal Business Name): AALOK DEVENDRA SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 W RAMSEY ST
BANNING CA
92220-3051
US

IV. Provider business mailing address

242 CAJON ST
REDLANDS CA
92373-5202
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-0313
  • Fax:
Mailing address:
  • Phone: 909-335-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC55973
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC55973
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC55973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: