Healthcare Provider Details

I. General information

NPI: 1134869845
Provider Name (Legal Business Name): RINKU K SHAH CERTIFIED ORTHOTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 CALLE DE LA PLATA STE 240
LAGUNA HILLS CA
92653-7623
US

IV. Provider business mailing address

15602 MOSHER AVE
TUSTIN CA
92780-6427
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-2050
  • Fax:
Mailing address:
  • Phone: 949-355-3675
  • Fax: 949-447-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCFM03462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: