Healthcare Provider Details

I. General information

NPI: 1912927500
Provider Name (Legal Business Name): VINEET KUMAR SHRIVASTAVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 400
LONG BEACH CA
90806-1553
US

IV. Provider business mailing address

PO BOX 513980
LOS ANGELES CA
90051-3980
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-8510
  • Fax:
Mailing address:
  • Phone: 714-456-6431
  • Fax: 714-456-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA86382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: