Healthcare Provider Details

I. General information

NPI: 1629845151
Provider Name (Legal Business Name): KARJA L SHURLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E RINCON ST STE 209
CORONA CA
92879-1379
US

IV. Provider business mailing address

15920 POMONA RINCON RD UNIT 6501
CHINO HILLS CA
91709-5533
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax:
Mailing address:
  • Phone: 845-313-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: