MEDICARE: DR. RENU RAKESH SHISHODIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A76232	CA

General Provider Information

NPI Number	:	1386785962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENU RAKESH SHISHODIA M.D.

Provider Business Mailing Address
First Line	:	3506 MONT BLANC TER
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93306-7562
Country	:	US
Telephone Number	:	661-872-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 COLUMBUS ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-1936
Country	:	US
Telephone Number	:	661-868-8200
Fax Number	:	661-868-8255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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