1386785962 NPI number — DR. RENU RAKESH SHISHODIA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386785962 NPI number — DR. RENU RAKESH SHISHODIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHISHODIA
Provider First Name:
RENU
Provider Middle Name:
RAKESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1386785962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 MAGNOLIA AVE
Provider Second Line Business Mailing Address:
STE 1F
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-737-1917
Provider Business Mailing Address Fax Number:
951-735-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41670 IVY ST.
Provider Second Line Business Practice Location Address:
STE C&D
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-9433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-696-5220
Provider Business Practice Location Address Fax Number:
951-356-4449
Provider Enumeration Date:
02/08/2007

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:  A76232 , 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)





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