Healthcare Provider Details

I. General information

NPI: 1851414569
Provider Name (Legal Business Name): ANUJA P. SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BLDG N-28
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST C1 ANNEX
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3891
  • Fax: 310-782-1837
Mailing address:
  • Phone: 310-222-3891
  • Fax: 310-782-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA96125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: