Provider Demographics
NPI:1194741330
Name:SHANBHAG, VINAYAK S (MD)
Entity type:Individual
Prefix:DR
First Name:VINAYAK
Middle Name:S
Last Name:SHANBHAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3918
Mailing Address - Country:US
Mailing Address - Phone:714-532-6811
Mailing Address - Fax:714-532-5487
Practice Address - Street 1:810 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3918
Practice Address - Country:US
Practice Address - Phone:714-532-6811
Practice Address - Fax:714-532-5487
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA341872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE54474Medicare UPIN
CAA34187Medicare PIN