Provider Demographics
NPI:1649635004
Name:GEORGE, SHOBA
Entity type:Individual
Prefix:MRS
First Name:SHOBA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHOBA
Other - Middle Name:BARUCH
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:10746 FRANCIS PL APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7723
Mailing Address - Country:US
Mailing Address - Phone:818-331-0916
Mailing Address - Fax:
Practice Address - Street 1:10746 FRANCIS PL APT 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7723
Practice Address - Country:US
Practice Address - Phone:818-331-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001222363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care