=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669790291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY ORTHOPEDIC INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2010
-----------------------------------------------------
Last Update Date | 01/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1533 N DOWNS ST
-----------------------------------------------------
City | RIDGECREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93555-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-446-2900
-----------------------------------------------------
Fax | 661-948-2210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 647 W AVENUE Q
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-3893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-949-8643
-----------------------------------------------------
Fax | 661-947-1361
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE SECRETARY
-----------------------------------------------------
Name | ANAND M SHAH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 661-949-8643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A102466
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------