Healthcare Provider Details

I. General information

NPI: 1699069070
Provider Name (Legal Business Name): SHASHANK ARYA MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

13 SILVER FOREST CT
AZUSA CA
91702-6276
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA80526
License Number StateCA

VIII. Authorized Official

Name: DR. SASHANK ARYA
Title or Position: PRESIDENT
Credential:
Phone: 909-636-3926