Individual
TYANA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4965 RIDGEVIEW DR, ANTIOCH, CA 94531-7757
(510) 703-2130
Mailing address
4965 RIDGEVIEW DR, ANTIOCH, CA 94531-7757
(510) 703-2130
Taxonomy
Speciality
Code
Description
License number
State
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
Primary
207RI0001
CA
Other
Enumeration date
10/20/2022
Last updated
11/12/2022
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