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General NPI Number Information
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NPI Number | 1609711894
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Entity Type | Organization
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Legal Business Name | SHORECREST LEGACY GROUP LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 1424 26TH ST UNIT 1
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City | SANTA MONICA
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State | CA
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Zip | 90404-3059
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Country | US
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Telephone | 310-310-9813
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 26TH ST UNIT 1
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City | SANTA MONICA
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State | CA
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Zip | 90404-3059
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Country | US
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Telephone | 310-310-9813
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ADRIENNE BURROWS
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Credential | MD
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Telephone | 310-310-9813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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