Healthcare Provider Details

I. General information

NPI: 1770508582
Provider Name (Legal Business Name): UJJWALA SHAH DHEERIYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOMITA BLVD.
TORRANCE CA
90505
US

IV. Provider business mailing address

2900 LOMITA BLVD.
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-8713
  • Fax: 310-784-4991
Mailing address:
  • Phone: 310-377-2707
  • Fax: 310-377-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA70781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA70781
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA71781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: