Healthcare Provider Details

I. General information

NPI: 1902719024
Provider Name (Legal Business Name): SHELBY MARTINDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST
CORONA CA
92882-3301
US

IV. Provider business mailing address

222 W 6TH ST
CORONA CA
92882-3301
US

V. Phone/Fax

Practice location:
  • Phone: 888-682-6282
  • Fax: 888-507-7087
Mailing address:
  • Phone: 888-682-6282
  • Fax: 888-507-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: