Healthcare Provider Details

I. General information

NPI: 1699599258
Provider Name (Legal Business Name): SHIBANGI PAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE # MER-35
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

8560 FOXCROFT PL
SAN DIEGO CA
92129-3729
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7220
  • Fax:
Mailing address:
  • Phone: 858-842-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: