Provider Demographics
NPI:1487477600
Name:AVANI PATEL SHAH MD INC
Entity type:Organization
Organization Name:AVANI PATEL SHAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-912-2979
Mailing Address - Street 1:1682 N ROCKY RD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-2501
Mailing Address - Country:US
Mailing Address - Phone:909-912-2979
Mailing Address - Fax:909-660-8652
Practice Address - Street 1:5632 PHILADELPHIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-8702
Practice Address - Country:US
Practice Address - Phone:909-660-8585
Practice Address - Fax:909-660-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty