Provider Demographics
NPI:1629045125
Name:DHRUVA, SHISHIR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHISHIR
Middle Name:A
Last Name:DHRUVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHISHIR
Other - Middle Name:A
Other - Last Name:DHRUVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1335 BUENAVENTURA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0160
Mailing Address - Country:US
Mailing Address - Phone:530-247-7246
Mailing Address - Fax:530-245-0849
Practice Address - Street 1:1335 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0160
Practice Address - Country:US
Practice Address - Phone:530-247-7246
Practice Address - Fax:530-245-0849
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43275208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA043275OtherLICENSE #
CAGR0055650Medicaid
CAGR0055650Medicaid
CAA043275OtherLICENSE #
CAGR0055650Medicaid