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General NPI Number Information
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NPI Number | 1104541572
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Entity Type | Organization
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Legal Business Name | DR SHANNA R NEWBOLD M D INC
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 264 N HIGHLAND SPRINGS AVE STE A
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City | BANNING
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State | CA
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Zip | 92220-3082
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Country | US
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Telephone | 909-556-7694
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Fax |
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Provider Business Mailing Address
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Address Line | 350 TERRACINA BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-4850
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNA NEWBOLD
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Credential | MD
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Telephone | 909-556-7694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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