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	:	770 MAGNOLIA AVE
Second Line	:	STE 1F
City	:	CORONA
State	:	CA
Zip	:	92879-3121
Country	:	US
Telephone Number	:	951-737-1917
Fax Number	:	951-735-4105

Provider Business Practice Location Address
First Line	:	41670 IVY ST.
Second Line	:	STE C&D
City	:	MURRIETA
State	:	CA
Zip	:	92562-9433
Country	:	US
Telephone Number	:	951-696-5220
Fax Number	:	951-356-4449

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/24/2026

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