Basic Information
| Provider Information | |||||||||
| NPI: | 1043205784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOWAH | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 CUYAMACA ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920712692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192586200 | ||||||||
| FaxNumber: | 6192580028 | ||||||||
| Practice Location | |||||||||
| Address1: | 6260 EL CAMINO REAL # 100 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920091609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604762953 | ||||||||
| FaxNumber: | 7604762963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | A52139 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 207P00000X | A52139 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1023553633 | 05 | CA | MEDICAID |