Healthcare Provider Details

I. General information

NPI: 1003153412
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA NEUROLOGY AND PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

21270 BLUE HILLS DR
SARATOGA CA
95070-6517
US

V. Phone/Fax

Practice location:
  • Phone: 707-502-5519
  • Fax:
Mailing address:
  • Phone: 619-403-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC53290
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC53290
License Number StateCA

VIII. Authorized Official

Name: PANNA R SHAH
Title or Position: MD
Credential:
Phone: 619-403-1701