MEDICARE: MR. DARRELL E. SHURNEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10503	CA

General Provider Information

NPI Number	:	1851386387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRELL E. SHURNEY PA-C

Provider Business Mailing Address
First Line	:	1705 N MADISON AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1233
Country	:	US
Telephone Number	:	323-964-1863
Fax Number	:	626-791-0479

Provider Business Practice Location Address
First Line	:	25825 VERMONT AVE
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3518
Country	:	US
Telephone Number	:	310-517-3150
Fax Number	:	310-517-3369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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