Healthcare Provider Details

I. General information

NPI: 1326275306
Provider Name (Legal Business Name): PALLAV RAJESH SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 ESPLANADE
CHICO CA
95926-3315
US

IV. Provider business mailing address

1702 ESPLANADE
CHICO CA
95926-3315
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-0504
  • Fax: 530-898-9647
Mailing address:
  • Phone: 530-898-0504
  • Fax: 530-898-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA135420
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA135420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: