Healthcare Provider Details

I. General information

NPI: 1871744631
Provider Name (Legal Business Name): PRANJALI SHAH MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10719 HALEDON AVE
DOWNEY CA
90241-2814
US

IV. Provider business mailing address

10719 HALEDON AVE
DOWNEY CA
90241-2814
US

V. Phone/Fax

Practice location:
  • Phone: 562-441-2789
  • Fax:
Mailing address:
  • Phone: 562-441-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT2081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: