Healthcare Provider Details

I. General information

NPI: 1780881763
Provider Name (Legal Business Name): SHAMA AMBE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD
TORRANCE CA
90503-4607
US

IV. Provider business mailing address

10080 SAN MARCOS CT
LAS CRUCES NM
88007-8954
US

V. Phone/Fax

Practice location:
  • Phone: 915-542-0755
  • Fax: 915-542-0744
Mailing address:
  • Phone: 575-636-2592
  • Fax:

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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2009-0251
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD2009-0251
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: