Healthcare Provider Details

I. General information

NPI: 1366572737
Provider Name (Legal Business Name): SHINURA CONTESE RICARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 SUTTER AVE
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

9108 NAXOS WAY
ELK GROVE CA
95758-7031
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7640
  • Fax: 916-971-5711
Mailing address:
  • Phone: 916-395-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: