Healthcare Provider Details

I. General information

NPI: 1568762722
Provider Name (Legal Business Name): CIGAL TZIVIA SHAHAM M.D., M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR SUITE 311
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR SUITE 311
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-4586
  • Fax: 310-657-0986
Mailing address:
  • Phone: 310-657-4586
  • Fax: 310-657-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA114305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: