Healthcare Provider Details

I. General information

NPI: 1134748080
Provider Name (Legal Business Name): SHANNON RASMUSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON RASMUSSEN

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8345 FIRESTONE BLVD STE 310
DOWNEY CA
90241-3872
US

IV. Provider business mailing address

8345 FIRESTONE BLVD STE 310
DOWNEY CA
90241-3872
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-3001
  • Fax: 562-904-0321
Mailing address:
  • Phone: 562-923-3001
  • Fax: 562-904-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59765
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200776
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7680341-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: