Healthcare Provider Details

I. General information

NPI: 1669874467
Provider Name (Legal Business Name): SHELBY LUNDAHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

4101 TORRANCE BLVD RADIOLOGY DEPT
TORRANCE CA
90503-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-5750
  • Fax:
Mailing address:
  • Phone: 310-303-5750
  • Fax: 310-533-1841

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 State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA140432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: