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General NPI Number Information
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NPI Number | 1619716859
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Entity Type | Organization
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Legal Business Name | SHEPHERD MEDICAL STAFFING AGENCY L.L.C.
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1630 W REDLANDS BLVD STE I
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City | REDLANDS
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State | CA
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Zip | 92373-8032
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Country | US
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Telephone | 909-310-2145
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 W REDLANDS BLVD STE I
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City | REDLANDS
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State | CA
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Zip | 92373-8032
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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 | DANIEL YEBOAH
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Credential |
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Telephone | 951-897-2517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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