Healthcare Provider Details

I. General information

NPI: 1174152342
Provider Name (Legal Business Name): SHIVANGI MANIAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404 GENESEE AVE STE 340
LA JOLLA CA
92037-1356
US

IV. Provider business mailing address

9404 GENESEE AVE STE 340
LA JOLLA CA
92037-1356
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-0344
  • Fax: 858-248-4262
Mailing address:
  • Phone: 858-221-0344
  • Fax: 858-248-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1556
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: