Healthcare Provider Details

I. General information

NPI: 1477802221
Provider Name (Legal Business Name): RAJESH SHANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. CARSON STREET BOX 400
TORRANCE CA
90509-2910
US

IV. Provider business mailing address

1000 W. CARSON STREET BOX 400
TORRANCE CA
90509-2910
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2401
  • Fax:
Mailing address:
  • Phone: 310-222-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA127337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: