Provider Demographics
NPI:1376915462
Name:RAVI B SHAH, DO INC
Entity Type:Organization
Organization Name:RAVI B SHAH, DO INC
Other - Org Name:NORTH ORANGE COUNTY SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-577-9090
Mailing Address - Street 1:1275 N ROSE DR
Mailing Address - Street 2:SUITE #118
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1275 N ROSE DR
Practice Address - Street 2:SUITE #118
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3941
Practice Address - Country:US
Practice Address - Phone:714-577-9090
Practice Address - Fax:714-572-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty