Healthcare Provider Details

I. General information

NPI: 1164426961
Provider Name (Legal Business Name): SHIRLEY PUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 W HILLSDALE AVE
VISALIA CA
93291
US

IV. Provider business mailing address

5400 W HILLSDALE AVE
VISALIA CA
93291-8222
US

V. Phone/Fax

Practice location:
  • Phone: 559-738-7532
  • Fax: 559-739-2052
Mailing address:
  • Phone: 559-738-7532
  • Fax: 559-739-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31301
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC151394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: