1225083272 NPI number — MANISH V SHETH MD

Table of content: MANISH V SHETH MD (NPI 1225083272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225083272 NPI number — MANISH V SHETH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHETH
Provider First Name:
MANISH
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225083272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4510 EXECUTIVE DRIVE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-427-5060
Provider Business Mailing Address Fax Number:
619-383-6701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-427-5060
Provider Business Practice Location Address Fax Number:
619-383-6701
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  5295 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 46626 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: C53102 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040121002 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22037 . This is a "SANFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP40279 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 241810 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 57108C035 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 12200 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225083272 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370624200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4993237 . This is a "BLUE CROSS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: C53102 . This is a "CALIFORNIA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1225083272 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 412991040284 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5G434SH . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7101604 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5295 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 170133900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46022474352 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5G434SH . This is a "BLUE PLUS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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