Healthcare Provider Details

I. General information

NPI: 1467521989
Provider Name (Legal Business Name): APURVA V SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J SUITE C
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

40221 TESORO LN
PALMDALE CA
93551-4833
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax:
Mailing address:
  • Phone: 661-949-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA73519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: