Healthcare Provider Details

I. General information

NPI: 1922447937
Provider Name (Legal Business Name): RITI SHARMA DAYAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITI SHARMA

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 03/08/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR STE 203
IRVINE CA
92618-3181
US

IV. Provider business mailing address

18 ENDEAVOR STE 203
IRVINE CA
92618-3181
US

V. Phone/Fax

Practice location:
  • Phone: 949-910-1188
  • Fax:
Mailing address:
  • Phone: 949-910-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD449350
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101243100
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA138766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: