Provider Demographics
NPI:1912091364
Name:SHAH, HETA NEEL (PA-C)
Entity Type:Individual
Prefix:
First Name:HETA
Middle Name:NEEL
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6848 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2857
Mailing Address - Country:US
Mailing Address - Phone:714-680-9258
Mailing Address - Fax:
Practice Address - Street 1:6848 MAGNOLIA AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2857
Practice Address - Country:US
Practice Address - Phone:714-680-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-18369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant