Healthcare Provider Details

I. General information

NPI: 1003990151
Provider Name (Legal Business Name): DR. ROSHAN ARA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 310
OXNARD CA
93030-7647
US

IV. Provider business mailing address

1700 N ROSE AVE STE 310
OXNARD CA
93030-7647
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-1566
  • Fax: 805-983-3194
Mailing address:
  • Phone: 805-983-1566
  • Fax: 805-983-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA32996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: