Basic Information
| Provider Information | |||||||||
| NPI: | 1487917621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHABRANG | ||||||||
| FirstName: | CYRUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4002 VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609404055 | ||||||||
| FaxNumber: | 7609404084 | ||||||||
| Practice Location | |||||||||
| Address1: | 4002 VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609404055 | ||||||||
| FaxNumber: | 7609404084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 05/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301100774 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | PG183127 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0204X | A153042 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.