Healthcare Provider Details

I. General information

NPI: 1043627532
Provider Name (Legal Business Name): SHANE DSOUZA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N FIGUEROA ST SUITE 1225
LOS ANGELES CA
90012-2602
US

IV. Provider business mailing address

313 N FIGUEROA ST SUITE 1225
LOS ANGELES CA
90012-2602
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-7717
  • Fax: 213-975-9623
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 59988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: