Healthcare Provider Details

I. General information

NPI: 1184660771
Provider Name (Legal Business Name): HARSHA P SHETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 115
CHINO CA
91710-1401
US

IV. Provider business mailing address

13768 ROSWELL AVE SUITE 115
CHINO CA
91710-1401
US

V. Phone/Fax

Practice location:
  • Phone: 909-364-0600
  • Fax: 909-364-1126
Mailing address:
  • Phone: 909-364-0600
  • Fax: 909-364-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: