Healthcare Provider Details

I. General information

NPI: 1992263941
Provider Name (Legal Business Name): SHIANE LYANA FERRETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WEST 5TH STREET
LOS ANGELES CA
90013
US

IV. Provider business mailing address

13428 MAXELLA AVE STE 913
MARINA DEL REY CA
90292-5620
US

V. Phone/Fax

Practice location:
  • Phone: 424-272-5238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: