Healthcare Provider Details

I. General information

NPI: 1932407632
Provider Name (Legal Business Name): SHANNA R NEWBOLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 N HIGHLAND SPRINGS AVE STE A
BANNING CA
92220-3082
US

IV. Provider business mailing address

30200 OAK GROVE DR
REDLANDS CA
92373-9785
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-326-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA107472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA107472
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA107472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: