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General NPI Number Information
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NPI Number | 1639566367
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Entity Type | Organization
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Legal Business Name | SHREYA MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 2471 ROSSER DR
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City | CORONA
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State | CA
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Zip | 92879-3319
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Country | US
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Telephone | 951-642-9674
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Fax | 888-974-8638
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Provider Business Mailing Address
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Address Line | 2471 ROSSER DR
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City | CORONA
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State | CA
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Zip | 92879-3319
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Country | US
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Telephone | 951-642-9674
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Fax | 888-974-8638
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Authorized Official
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Title or Position | OWNER
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Name | TAPEESH KANSAL
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Credential | MD
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Telephone | 951-642-9674
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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 | C52158
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License Number State | CA
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