Healthcare Provider Details

I. General information

NPI: 1639366123
Provider Name (Legal Business Name): ALKA SUBHASH SHETH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE PEDIATRICS
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-9154
  • Fax: 619-795-9847
Mailing address:
  • Phone: 619-564-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: