Provider Demographics
NPI:1841351277
Name:IYER, SHILESH (MD)
Entity type:Individual
Prefix:MR
First Name:SHILESH
Middle Name:
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23861 MCBEAN PKWY
Mailing Address - Street 2:#E-21
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2058
Mailing Address - Country:US
Mailing Address - Phone:661-254-3686
Mailing Address - Fax:661-254-5671
Practice Address - Street 1:23861 MCBEAN PKWY
Practice Address - Street 2:#E-21
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2058
Practice Address - Country:US
Practice Address - Phone:661-254-3686
Practice Address - Fax:661-254-5671
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16330Medicare PIN
CAWA68406FMedicare PIN
CAH27746Medicare UPIN