Provider Demographics
NPI:1396730560
Name:SHAH, RUPAL B (MD)
Entity type:Individual
Prefix:
First Name:RUPAL
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 78016
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0133
Mailing Address - Country:US
Mailing Address - Phone:951-738-0303
Mailing Address - Fax:951-738-0393
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:SUITE 1K
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-738-0303
Practice Address - Fax:951-738-0393
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2012-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA51553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515530Medicaid
F82147Medicare UPIN
CA00A515530Medicaid