Healthcare Provider Details

I. General information

NPI: 1700124773
Provider Name (Legal Business Name): MEERA MISRA SHUKLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 MARGUERITE AVE
CORONA DEL MAR CA
92625-3043
US

IV. Provider business mailing address

219 MARGUERITE AVE
CORONA DEL MAR CA
92625-3043
US

V. Phone/Fax

Practice location:
  • Phone: 949-610-5139
  • Fax:
Mailing address:
  • Phone: 949-209-1563
  • Fax: 949-239-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA120624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: