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General NPI Number Information
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NPI Number | 1518384759
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Entity Type | Individual
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Provider Name | RAVI RAJ SHAH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 101 CIVIC CENTER LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5607
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Country | US
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Telephone | 928-855-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 2007 WREN WAY
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City | FULLERTON
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State | CA
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Zip | 92833-1548
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Country | US
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Telephone | 714-353-9142
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53853
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License Number State | AZ
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