Provider Demographics
NPI:1043566623
Name:MOHTASHAMI, SHIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:MOHTASHAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 180A
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8108
Mailing Address - Country:US
Mailing Address - Phone:408-356-8400
Mailing Address - Fax:855-834-6677
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 180A
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8108
Practice Address - Country:US
Practice Address - Phone:408-356-8400
Practice Address - Fax:855-834-6677
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine