Individual ProviderPravin ShawFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1190 Baker St Ste 100, Costa Mesa, CA 92626-4105(714) 668-2500PECOS EnrollmentBased on the most recent information from CMS, provider Pravin Shaw is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1407136187Provider TypeIndividualFull NameShaw, PravinTitleDr.CredentialD.O.GenderMaleSole ProprietorYesEnumeration Date8/25/2011Last Updated8/1/2013Contact InformationPractice LocationPractice Address1190 Baker St Ste 100, Costa Mesa, CA 92626-4105Phone(714) 668-2500Fax(714) 668-2515Mailing LocationMailing AddressPO Box 3699, Newport Beach, CA 92659-8699Phone(714) 668-2500Fax(714) 668-2515Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense20A11805California