Healthcare Provider Details

I. General information

NPI: 1326821349
Provider Name (Legal Business Name): RASHIDA SHAH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 101
RIVERSIDE CA
92506-0103
US

IV. Provider business mailing address

3062 PINEHURST DR
CORONA CA
92881-0930
US

V. Phone/Fax

Practice location:
  • Phone: 951-774-2860
  • Fax: 951-774-2861
Mailing address:
  • Phone: 562-572-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: