Healthcare Provider Details

I. General information

NPI: 1154315919
Provider Name (Legal Business Name): DAVID MARK SHAVELLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 250
LONG BEACH CA
90808-0016
US

IV. Provider business mailing address

3828 SCHAUFELE AVE STE 250
LONG BEACH CA
90808-0016
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-8990
  • Fax: 714-665-4664
Mailing address:
  • Phone: 657-241-8990
  • Fax: 714-665-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA54834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA54834
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA54834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: