Healthcare Provider Details

I. General information

NPI: 1669730339
Provider Name (Legal Business Name): EXECUTIVE GI SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 EL CAPITAN DR SUITE 110
DANVILLE CA
94526-6258
US

IV. Provider business mailing address

12935 ALCOSTA BLVD UNIT 3888
SAN RAMON CA
94583-6181
US

V. Phone/Fax

Practice location:
  • Phone: 925-866-9300
  • Fax: 866-867-2984
Mailing address:
  • Phone: 925-718-6622
  • Fax: 917-259-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. SALIM M SHELBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-866-9300