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General NPI Number Information
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NPI Number | 1437389889
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Entity Type | Organization
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Legal Business Name | SAPANA K SHAH MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 250 PROSPECT PL
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City | CORONADO
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State | CA
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Zip | 92118-1943
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Country | US
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Telephone | 619-522-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 7755 VIA FRANCESCO UNIT 3
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City | SAN DIEGO
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State | CA
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Zip | 92129-5151
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Country | US
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Telephone | 312-399-9006
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAPANA K SHAH
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Credential | M.D.
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Telephone | 312-399-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A101550
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License Number State | CA
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