Healthcare Provider Details

I. General information

NPI: 1285977215
Provider Name (Legal Business Name): SHAUN PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

IV. Provider business mailing address

PO BOX 888298
LOS ANGELES CA
90088-8298
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2121
  • Fax: 213-977-0950
Mailing address:
  • Phone: 888-854-3822
  • Fax: 770-701-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: