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General NPI Number Information
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NPI Number | 1174119077
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Entity Type | Individual
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Provider Name | SHANNA VAN DOREN CPHT
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 29676 RANCHO CALIFORNIA RD
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City | TEMECULA
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State | CA
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Zip | 92591-5283
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Country | US
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Telephone | 951-693-2704
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Fax | 401-652-1417
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Provider Business Mailing Address
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Address Line | 33443 SCARBOROUGH LN
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City | TEMECULA
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State | CA
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Zip | 92592-5632
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Country | US
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Telephone | 760-594-1332
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Fax | 401-652-1417
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | TCH30779
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License Number State | CA
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