Healthcare Provider Details

I. General information

NPI: 1013708577
Provider Name (Legal Business Name): DAVON SHELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 ANGELES VISTA BLVD
VIEW PARK CA
90043-1737
US

IV. Provider business mailing address

11626 PRAIRIE DR
ADELANTO CA
92301-4280
US

V. Phone/Fax

Practice location:
  • Phone: 951-662-6234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: