Healthcare Provider Details

I. General information

NPI: 1487917621
Provider Name (Legal Business Name): CYRUS SHABRANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 05/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056
US

IV. Provider business mailing address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-4055
  • Fax: 760-940-4084
Mailing address:
  • Phone: 760-940-4055
  • Fax: 760-940-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301100774
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPG183127
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA153042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: