Healthcare Provider Details

I. General information

NPI: 1588964159
Provider Name (Legal Business Name): NURSE PRACTITIONERS OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25105 CLOVER CREEK LN
MENIFEE CA
92584-8456
US

IV. Provider business mailing address

26025 NEWPORT ROAD SUITE A 305
MENIFEE CA
92584
UM

V. Phone/Fax

Practice location:
  • Phone: 951-852-8505
  • Fax: 951-746-3496
Mailing address:
  • Phone: 951-852-8505
  • Fax: 951-746-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18946
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18946
License Number StateCA

VIII. Authorized Official

Name: DEBORAH LOUISE SHANNON
Title or Position: FOUNDER
Credential: N.P.
Phone: 951-852-8505