Healthcare Provider Details

I. General information

NPI: 1104759919
Provider Name (Legal Business Name): JONATHAN SHEARER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JON SHEARER

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E BRIER DR
SAN BERNARDINO CA
92408-2817
US

IV. Provider business mailing address

PO BOX 208
FOREST FALLS CA
92339-0208
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax:
Mailing address:
  • Phone: 951-202-6734
  • Fax: 951-202-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: