Healthcare Provider Details

I. General information

NPI: 1891496857
Provider Name (Legal Business Name): ADRIANA A SHAVLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 W PAOLI LN
WEIMAR CA
95736
US

IV. Provider business mailing address

PO BOX 1983
COLFAX CA
95713-1983
US

V. Phone/Fax

Practice location:
  • Phone: 530-637-4025
  • Fax:
Mailing address:
  • Phone: 949-533-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: