Healthcare Provider Details

I. General information

NPI: 1780048769
Provider Name (Legal Business Name): SHADI MILANI-NEJAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 280
RIVERSIDE CA
92505-3370
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 280
RIVERSIDE CA
92505-3370
US

V. Phone/Fax

Practice location:
  • Phone: 951-785-7190
  • Fax: 951-688-7246
Mailing address:
  • Phone: 951-785-7190
  • Fax: 951-688-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A16024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: