Provider Demographics
NPI:1356370209
Name:RAH, SHAHLA P (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:P
Last Name:RAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAHLA
Other - Middle Name:P
Other - Last Name:DURRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1441 AVOCADO AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7704
Mailing Address - Country:US
Mailing Address - Phone:949-650-6700
Mailing Address - Fax:949-650-6700
Practice Address - Street 1:1441 AVOCADO AVE STE 309
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7704
Practice Address - Country:US
Practice Address - Phone:949-650-6700
Practice Address - Fax:949-650-6707
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51993207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51993OtherCALIFORNIA MEDICAL LICENSE
CA00C519930Medicaid
CA1356370209Medicaid