Healthcare Provider Details

I. General information

NPI: 1083557250
Provider Name (Legal Business Name): SHAMEKA MCGOWAN-DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 RIMPAU AVE STE 213
CORONA CA
92879-7522
US

IV. Provider business mailing address

3217 CARSON ST STE 384
LAKEWOOD CA
90712-4006
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-6272
  • Fax: 951-268-6870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: