Healthcare Provider Details

I. General information

NPI: 1851484810
Provider Name (Legal Business Name): PUSHPA H. SHAHANI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

225 S LAKE AVE #535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-7100
  • Fax: 818-952-4618
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA32555
License Number StateCA

VIII. Authorized Official

Name: DR. PUSHPA HIRO SHAHANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-509-0939