Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 33025 | CA |
Y | 213ER0200X | Radiology | 33025 | CA |
NPI | 1487117719 |
---|---|
Provider Name | Dr. Savannah Shortz |
First Address | Hayward, CA 94545-2801 |
Second Address | Hayward, CA 94545-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 12/04/2019 |