Healthcare Provider Details

I. General information

NPI: 1952441396
Provider Name (Legal Business Name): RENATA SHAFOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10052 MESA RIDGE CT SUITE 101
SAN DIEGO CA
92121-2971
US

IV. Provider business mailing address

11010 ARROW RTE SUITE 109
RANCHO CUCAMONGA CA
91730-4826
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-0550
  • Fax: 858-657-0559
Mailing address:
  • Phone: 909-481-2577
  • Fax: 909-481-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA41108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: