Healthcare Provider Details

I. General information

NPI: 1730446709
Provider Name (Legal Business Name): LINA SARTHI SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD
OXNARD CA
93036-8210
US

IV. Provider business mailing address

2240 E GONZALES RD
OXNARD CA
93036-8210
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5365
  • Fax: 805-658-4580
Mailing address:
  • Phone: 805-981-5365
  • Fax: 805-658-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA136716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: