Provider Demographics
NPI:1427446517
Name:SHAH, TIRATH (DO)
Entity type:Individual
Prefix:
First Name:TIRATH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3066
Mailing Address - Country:US
Mailing Address - Phone:714-203-1799
Mailing Address - Fax:714-203-1716
Practice Address - Street 1:380 W CENTRAL AVE STE 400
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-203-1799
Practice Address - Fax:714-203-1716
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13052207Q00000X
CA20A17092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine