Healthcare Provider Details

I. General information

NPI: 1376152074
Provider Name (Legal Business Name): MEERA SHAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 N TORREY PINES RD
LA JOLLA CA
92037-1036
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-8646
  • Fax:
Mailing address:
  • Phone: 858-554-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: