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General NPI Number Information
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NPI Number | 1225083272
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Entity Type | Individual
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Provider Name | MANISH V SHETH MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 4510 EXECUTIVE DR SUITE 115
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City | SAN DIEGO
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State | CA
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Zip | 92121-3021
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Country | US
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Telephone | 858-427-5060
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Fax | 619-383-6701
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Provider Business Mailing Address
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Address Line | 4510 EXECUTIVE DRIVE SUITE 115
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-427-5060
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Fax | 619-383-6701
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5295
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 46626
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C53102
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License Number State | CA
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