Healthcare Provider Details

I. General information

NPI: 1902399470
Provider Name (Legal Business Name): ZUBIN SHETTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR STE 108
ENCINITAS CA
92024-5141
US

IV. Provider business mailing address

21250 HAWTHORNE BLVD STE 600
TORRANCE CA
90503-5519
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-4558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD-50949
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4351038068
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA201947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: