Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G50969 | CA |
N | 207NS0135X | Procedural Dermatology | G50969 | CA |
NPI | 1003922162 |
---|---|
Provider Name | Ava T Shamban |
First Address | Yucca Valley, CA 92286-2248 |
Second Address | Santa Monica, CA 90404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 17/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57567 | (02) | |
E7567 | (02) | CA |