Healthcare Provider Details

I. General information

NPI: 1437645256
Provider Name (Legal Business Name): MYRA RASHMI DEPERALTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRA RASHMI SHAH MD

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3891
  • Fax:
Mailing address:
  • Phone: 310-222-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC209072
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22606
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: