Healthcare Provider Details

I. General information

NPI: 1255952503
Provider Name (Legal Business Name): SAMIR PRANAV SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR STE 200
SANTA CLARITA CA
91355-5430
US

IV. Provider business mailing address

23501 CINEMA DR STE 200
SANTA CLARITA CA
91355-5430
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-4842
  • Fax:
Mailing address:
  • Phone: 661-288-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA177207
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1255952503
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTL3229
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA177207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: