NPIMap

Organization Active NPI

Southern California Neurology and Psychiatry

  • Neurology Physician
  • La Jolla, CA
National Provider Identifier
1114271665
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
C53290 Issued in CA
Legal business name
SOUTHERN CALIFORNIA NEUROLOGY AND PSYCHIATRY
Practice address
4275 Executive SQ Ste 200
La Jolla, CA 92037-1476
Phone
(619) 403-1701
Fax
(619) 810-2863
NPI assigned
Nov 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Panna Ramanlal Shah, MDNPI 1780659763
Title
Physician
Phone
(619) 403-1701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X C53290 CA Primary

Addresses

Primary practice location

4275 Executive SQ Ste 200
La Jolla, CA 92037-1476

Mailing address

1212 San Dieguito Dr
Encinitas, CA 92024-5115
Phone (619) 403-1701

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1114271665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 SAN DIEGUITO DR",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245115",
            "telephone_number": "619-403-1701",
            "fax_number": "619-810-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4275 EXECUTIVE SQ STE 200",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371476",
            "telephone_number": "619-403-1701",
            "fax_number": "619-810-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA NEUROLOGY AND PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "PANNA",
        "authorized_official_middle_name": "RAMANLAL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "619-403-1701",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "C53290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.