Provider Demographics
NPI:1114347507
Name:SOUTHERN CALIFORNIA INFECTIOUS DISEASE PHYSICIANS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA INFECTIOUS DISEASE PHYSICIANS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-810-3330
Mailing Address - Street 1:18335 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5968
Mailing Address - Country:US
Mailing Address - Phone:626-810-3330
Mailing Address - Fax:626-964-0440
Practice Address - Street 1:18335 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5968
Practice Address - Country:US
Practice Address - Phone:626-810-3330
Practice Address - Fax:626-964-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty