Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A26626 | CA |
NPI | 1003920315 |
---|---|
Provider Name | Dr. Anjana Pradip Shah |
First Address | West Covina, CA 91790-3409 |
Second Address | West Covina, CA 91790-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A83415 | (02) | CA |