Healthcare Provider Details

I. General information

NPI: 1386144392
Provider Name (Legal Business Name): SHANNON M VOSS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

IV. Provider business mailing address

3939 E ALLIN ST UNIT 304
LONG BEACH CA
90803-2875
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-4525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55308
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: