Healthcare Provider Details

I. General information

NPI: 1497939896
Provider Name (Legal Business Name): MARTA M SHINN PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 HYLAND AVE STE 205
COSTA MESA CA
92626-1403
US

IV. Provider business mailing address

1048 IRVINE AVE # 717
NEWPORT BEACH CA
92660-4602
US

V. Phone/Fax

Practice location:
  • Phone: 949-873-4617
  • Fax: 949-209-4544
Mailing address:
  • Phone: 949-873-4617
  • Fax: 949-209-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberPSY23107
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY23107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: