Individual
SHANTHARAM PAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
511 AMIGOS DR STE C, REDLANDS, CA 92373-6283
(909) 799-7111
(909) 498-5154
Mailing address
511 AMIGOS DR STE C, REDLANDS, CA 92373-6283
(909) 799-7111
(909) 498-5154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A442860
CA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
A442860
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A442860
BLUE SHIELD OF CA
CA
05
—
00A442861
—
CA
01
—
080101190
RAILROAD MEDICARE
GA
01
—
CA131554
MEDICARE
CA
Enumeration date
06/21/2005
Last updated
09/10/2025
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