Basic Information
Provider Information
NPI: 1861688079
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHAW
FirstName: DARINKA
MiddleName: T
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 EAST CENTER AVE.
Address2:  
City: VISALIA
State: CA
PostalCode: 932916331
CountryCode: US
TelephoneNumber: 5597374700
FaxNumber: 5597374782
Practice Location
Address1: 400 EAST OAK STREET
Address2:  
City: VISALIA
State: CA
PostalCode: 932915034
CountryCode: US
TelephoneNumber: 5597414500
FaxNumber: 5597414502
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 07/31/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XBP10028145TXN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XA111244CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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