Healthcare Provider Details

I. General information

NPI: 1346838398
Provider Name (Legal Business Name): SHAYNA L HOLLINQUEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 S WESTERN AVE
LOS ANGELES CA
90047-4456
US

IV. Provider business mailing address

12003 AVALON BLVD STE 109
LOS ANGELES CA
90061-2859
US

V. Phone/Fax

Practice location:
  • Phone: 323-315-8232
  • Fax:
Mailing address:
  • Phone: 323-483-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: