Basic Information
| Provider Information | |||||||||
| NPI: | 1164413514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIFFMAN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2742 DOW AVE | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927807242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146651600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29472 AVENIDA DE LAS BANDERA | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926882651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494599968 | ||||||||
| FaxNumber: | 9497662565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A45794 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A457940 | 05 | CA | MEDICAID |