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General NPI Number Information
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NPI Number | 1760679260
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Entity Type | Organization
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Legal Business Name | PURNIMA B. SHAH, M.D., INC, A CALIFORNIA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 15107 VANOWEN ST
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City | VAN NUYS
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State | CA
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Zip | 91405-4542
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Country | US
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Telephone | 818-902-2951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | SIMI VALLEY
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State | CA
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Zip | 93062-0190
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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 | PRESIDENT
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Name | PUNIMA SHAH I
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Credential | M.D.
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Telephone | 818-902-3967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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