Healthcare Provider Details

I. General information

NPI: 1871594648
Provider Name (Legal Business Name): VALERY P SHULMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VAL P SHULMAN M.D.

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 SANTA MONICA BLVD 200
WEST HOLLYWOOD CA
90046-6406
US

IV. Provider business mailing address

7559 SANTA MONICA BLVD 200
WEST HOLLYWOOD CA
90046-6406
US

V. Phone/Fax

Practice location:
  • Phone: 323-878-2523
  • Fax:
Mailing address:
  • Phone: 323-878-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA38820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA38820
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA38820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: