Healthcare Provider Details

I. General information

NPI: 1942457999
Provider Name (Legal Business Name): SHILPA DIWAN M.D, M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC134348
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC134348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: