Healthcare Provider Details

I. General information

NPI: 1669808549
Provider Name (Legal Business Name): SHELLEY ANNE BAELLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY ANNE CAMPBELL-BAELLA

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 TEMECULA PKWY
TEMECULA CA
92592-5896
US

IV. Provider business mailing address

10203 GLEN IVY RD
CORONA CA
92883-5185
US

V. Phone/Fax

Practice location:
  • Phone: 951-316-4621
  • Fax:
Mailing address:
  • Phone: 951-316-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: