Healthcare Provider Details

I. General information

NPI: 1992935068
Provider Name (Legal Business Name): SHOBHA RANI C MAHESH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHOBHA RANI HOLALU CHOWDIAH M.D.

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26882 TOWNE CENTRE DR
FOOTHILL RANCH CA
92610-2862
US

IV. Provider business mailing address

26882 TOWNE CENTRE DR
FOOTHILL RANCH CA
92610-2862
US

V. Phone/Fax

Practice location:
  • Phone: 949-455-8559
  • Fax: 949-455-8561
Mailing address:
  • Phone: 949-455-8559
  • Fax: 949-455-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA105302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: