Healthcare Provider Details

I. General information

NPI: 1790863280
Provider Name (Legal Business Name): SHAMSI M. VATANNIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27212 CALAROGA AVE
HAYWARD CA
94545-4339
US

IV. Provider business mailing address

27212 CALAROGA AVE
HAYWARD CA
94545-4339
US

V. Phone/Fax

Practice location:
  • Phone: 510-785-5000
  • Fax:
Mailing address:
  • Phone: 510-785-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA96343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: