Basic Information
| Provider Information | |||||||||
| NPI: | 1598854044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRIBHUWAN | ||||||||
| FirstName: | SHASHIKALA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11704 WILEY ST | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097962175 | ||||||||
| FaxNumber: | 9097962175 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 WESTERN AVE | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924111356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098873087 | ||||||||
| FaxNumber: | 9098872974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A46690 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.