Provider Demographics
NPI:1972943579
Name:SHAH, ANGANA (RD)
Entity type:Individual
Prefix:
First Name:ANGANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 CALLE BOGOTA
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748
Mailing Address - Country:US
Mailing Address - Phone:626-991-2784
Mailing Address - Fax:
Practice Address - Street 1:234 S EL MOLINO AVE
Practice Address - Street 2:APT#5
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2965
Practice Address - Country:US
Practice Address - Phone:626-991-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01078114133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered