Healthcare Provider Details

I. General information

NPI: 1588836274
Provider Name (Legal Business Name): SHAWN URAINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25805 BARTON RD SUITE A106
LOMA LINDA CA
92354-3814
US

IV. Provider business mailing address

PO BOX 119
LOMA LINDA CA
92354-0119
US

V. Phone/Fax

Practice location:
  • Phone: 909-333-4200
  • Fax: 909-333-4205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA108851
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA08851
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberA108851
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA108851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: