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General NPI Number Information
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NPI Number | 1316140049
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Entity Type | Individual
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Provider Name | RAVI B SHAH D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 16671 E. YORBA LINDA BLVD SUITE 100
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City | YORBA LINDA
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State | CA
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Zip | 92886
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Country | US
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Telephone | 714-577-9090
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Fax | 714-572-8483
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Provider Business Mailing Address
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Address Line | 16671 E. YORBA LINDA BLVD SUITE 100
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City | YORBA LINDA
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State | CA
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Zip | 92886
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Country | US
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Telephone | 714-577-9090
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Fax | 714-572-8483
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20A 9434
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License Number State | CA
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