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General NPI Number Information
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NPI Number | 1245604214
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Entity Type | Organization
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Legal Business Name | DENTAL HYGIENE PRACTICE OF SHANAY FRY, RDHAP
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 13646 ABANA DR
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City | CERRITOS
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State | CA
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Zip | 90703-1003
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Country | US
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Telephone | 949-702-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 13646 ABANA DR
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City | CERRITOS
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State | CA
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Zip | 90703-1003
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Country | US
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Telephone | 949-702-6306
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHANAY LYNN FRY
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Credential | RDHAP
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Telephone | 949-702-6306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 587
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 587
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 587
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 587
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 587
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License Number State | CA
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