Provider Demographics
NPI:1528174778
Name:HARSHA P SHETH M.D., INC
Entity type:Organization
Organization Name:HARSHA P SHETH M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-364-0060
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-364-0060
Mailing Address - Fax:909-364-1126
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-364-0060
Practice Address - Fax:909-364-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10971999OtherCAQH