Healthcare Provider Details

I. General information

NPI: 1629045125
Provider Name (Legal Business Name): SHISHIR A DHRUVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHISHIR A DHRUVA MD

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 BUENAVENTURA BLVD SUITE 100
REDDING CA
96001-0160
US

IV. Provider business mailing address

1335 BUENAVENTURA BLVD STE 100
REDDING CA
96001-0160
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-7246
  • Fax: 530-245-0849
Mailing address:
  • Phone: 530-247-7246
  • Fax: 530-245-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA43275
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA43275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: