Provider Demographics
NPI:1316466287
Name:SHAH, MILI (LAC)
Entity type:Individual
Prefix:
First Name:MILI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11624 CANDY ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3852
Mailing Address - Country:US
Mailing Address - Phone:619-839-9018
Mailing Address - Fax:619-331-2983
Practice Address - Street 1:1281 UNIVERSITY AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7305
Practice Address - Country:US
Practice Address - Phone:619-839-9018
Practice Address - Fax:619-311-2983
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14102102OtherCAQH