Healthcare Provider Details

I. General information

NPI: 1508550674
Provider Name (Legal Business Name): SHANNON ROCHELL JONES BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 S VERMONT AVE FL 1
LOS ANGELES CA
90044-3493
US

IV. Provider business mailing address

8300 S VERMONT AVE FL 1
LOS ANGELES CA
90044-3493
US

V. Phone/Fax

Practice location:
  • Phone: 323-525-6400
  • Fax:
Mailing address:
  • Phone: 323-525-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: