Individual
DR. DEEPAK A SHIVARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44215 15TH ST W STE 111, LANCASTER, CA 93534-5503
(661) 949-5941
(661) 949-5871
Mailing address
44215 15TH ST W, STE. 111, LANCASTER, CA 93534-4014
(661) 949-5941
(661) 949-5871
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A62177
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A621770
—
CA
01
—
331042573
TAX ID#
CA
Enumeration date
10/31/2005
Last updated
02/26/2020
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