Healthcare Provider Details

I. General information

NPI: 1902458524
Provider Name (Legal Business Name): SHILPA DIWAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19772 MACARTHUR BLVD STE 220
IRVINE CA
92612-2405
US

IV. Provider business mailing address

6 VENTURE STE 350
IRVINE CA
92618-7350
US

V. Phone/Fax

Practice location:
  • Phone: 949-304-6727
  • Fax: 949-312-5638
Mailing address:
  • Phone: 949-304-6727
  • Fax: 760-859-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SHILPA DIWAN
Title or Position: PRESIDENT
Credential: MD
Phone: 949-304-6727