Healthcare Provider Details

I. General information

NPI: 1649102948
Provider Name (Legal Business Name): RITA SHAMMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W MAIN ST
EL CAJON CA
92020-3963
US

IV. Provider business mailing address

2975 STONEFIELD DR
JAMUL CA
91935-1660
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-4030
  • Fax:
Mailing address:
  • Phone: 619-414-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: