=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962268466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEVAL A. SHAH, M.D., APMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2024
-----------------------------------------------------
Last Update Date | 02/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12625 HIGH BLUFF DR STE 202
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-733-4345
-----------------------------------------------------
Fax | 253-455-7891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12625 HIGH BLUFF DR STE 202
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-733-4345
-----------------------------------------------------
Fax | 253-455-7891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DEVAL AJIT SHAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-714-9820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------