Healthcare Provider Details

I. General information

NPI: 1770196958
Provider Name (Legal Business Name): SHAWN AMPARANO M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 ATLANTA AVE STE H2A
RIVERSIDE CA
92507-0526
US

IV. Provider business mailing address

1737 ATLANTA AVE STE H2A
RIVERSIDE CA
92507-0526
US

V. Phone/Fax

Practice location:
  • Phone: 818-285-8252
  • Fax:
Mailing address:
  • Phone: 818-285-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: