Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A109648 | CA |
Y | 111NI0900X | Internist | A109648 | CA |
N | 207R00000X | Internist | BD6377712-952 | AZ |
N | 111NI0900X | Internist | BD6377712-952 | AZ |
NPI | 1003022682 |
---|---|
Provider Name | Maulik Shah |
First Address | Clovis, CA 93619-5098 |
Second Address | Fresno, CA 93720-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 30/09/2017 |