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General NPI Number Information
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NPI Number | 1447202833
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Entity Type | Individual
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Provider Name | WILLIAM VAN RONKEL SHELLOW M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-268-3153
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Fax | 310-268-4988
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Provider Business Mailing Address
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Address Line | 1757 ROSCOMARE RD
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City | LOS ANGELES
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State | CA
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Zip | 90077-2212
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G10047
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License Number State | CA
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