Individual
SHIVA G GOLSHANI-HEBRONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11833 WILMINGTON AVE, LOS ANGELES, CA 90059-3015
(310) 678-8672
Mailing address
11833 WILMINGTON AVE, LOS ANGELES, CA 90059-3015
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G78243
CA
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
G078243
CA
208D00000X
General Practice Physician
Primary
G078243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMS169253
CA MEDI-CAL
CA
Enumeration date
12/06/2006
Last updated
04/19/2023
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