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General NPI Number Information
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NPI Number | 1194923326
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Entity Type | Individual
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Provider Name | SHERVIN SHAMTOUB D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1401 SOUTH GRAND AVENUE.
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City | LOS ANGELES
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State | CA
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Zip | 90015
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Country | US
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Telephone | 818-416-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 5632 VAN NUYS BLVD UNIT 1527
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-4602
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Country | US
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Telephone | 818-416-2919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4734
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License Number State | CA
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