Healthcare Provider Details

I. General information

NPI: 1285578435
Provider Name (Legal Business Name): NATHAN SHEPHERD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAC HEALTH 250 S. G ST.
SAN BERNARDINO CA
92410
US

IV. Provider business mailing address

1400 BARTON RD APT 2107
REDLANDS CA
92373-5432
US

V. Phone/Fax

Practice location:
  • Phone: 510-830-7852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: