Healthcare Provider Details

I. General information

NPI: 1942040423
Provider Name (Legal Business Name): SHAWN DOYLE RAD T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 6TH ST
HUNTINGTON BEACH CA
92648-5004
US

IV. Provider business mailing address

226 6TH ST
HUNTINGTON BEACH CA
92648-5004
US

V. Phone/Fax

Practice location:
  • Phone: 415-683-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: