Provider Demographics
NPI:1629633755
Name:SHAAYA, RANS
Entity type:Individual
Prefix:
First Name:RANS
Middle Name:
Last Name:SHAAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BALLARD ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2124
Mailing Address - Country:US
Mailing Address - Phone:619-792-2636
Mailing Address - Fax:
Practice Address - Street 1:520 BALLARD ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2124
Practice Address - Country:US
Practice Address - Phone:619-792-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA474947809Medicaid