Healthcare Provider Details

I. General information

NPI: 1275578916
Provider Name (Legal Business Name): STEPHEN R. SHAW, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 LOMA VISTA RD SUITE B
VENTURA CA
93003-3016
US

IV. Provider business mailing address

3418 LOMA VISTA RD SUITE B
VENTURA CA
93003-3016
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-0128
  • Fax: 805-656-3421
Mailing address:
  • Phone: 805-642-0128
  • Fax: 805-656-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG47926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG50864
License Number StateCA

VIII. Authorized Official

Name: MS. JOANNE FORLAW
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-642-0128