Provider Demographics
NPI:1699741389
Name:SHAMTOB, RAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:SHAMTOB
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 1:16550 VENTURA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5058
Mailing Address - Country:US
Mailing Address - Phone:818-646-0149
Mailing Address - Fax:
Practice Address - Street 1:16550 VENTURA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5058
Practice Address - Country:US
Practice Address - Phone:818-307-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75153208VP0014X
CAG75153B207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G751530Medicaid
CA00G751530OtherBLUE SHIELD
CAWG75153BMedicare PIN
CA00G751530Medicaid