Healthcare Provider Details

I. General information

NPI: 1770424129
Provider Name (Legal Business Name): JANICE SHORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9390 HESPERIA RD
HESPERIA CA
92345-3602
US

IV. Provider business mailing address

612 S MYRTLE AVE STE 100
MONROVIA CA
91016-3406
US

V. Phone/Fax

Practice location:
  • Phone: 800-702-0272
  • Fax:
Mailing address:
  • Phone: 800-207-0272
  • 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: