Provider Demographics
NPI:1154645398
Name:JAMSHEED JAMES SHAMLOO MD INC
Entity Type:Organization
Organization Name:JAMSHEED JAMES SHAMLOO MD INC
Other - Org Name:MT. VERNON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMSHEED
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAMLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-422-8015
Mailing Address - Street 1:1023 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4202
Mailing Address - Country:US
Mailing Address - Phone:909-422-8015
Mailing Address - Fax:909-422-0625
Practice Address - Street 1:1023 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4202
Practice Address - Country:US
Practice Address - Phone:909-422-8015
Practice Address - Fax:909-422-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89604208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8440339Medicaid