Healthcare Provider Details

I. General information

NPI: 1437389889
Provider Name (Legal Business Name): SAPANA K SHAH MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PROSPECT PL
CORONADO CA
92118-1943
US

IV. Provider business mailing address

7755 VIA FRANCESCO UNIT 3
SAN DIEGO CA
92129-5151
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-3722
  • Fax:
Mailing address:
  • Phone: 312-399-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA101550
License Number StateCA

VIII. Authorized Official

Name: SAPANA K SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-399-9006