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General NPI Number Information
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NPI Number | 1639307895
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Entity Type | Individual
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Provider Name | SHANICKA N SCARBROUGH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 3746 FOOTHILL BLVD # B140
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City | GLENDALE
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State | CA
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Zip | 91214-1740
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Country | US
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Telephone | 310-445-5999
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Fax | 323-544-4248
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Provider Business Mailing Address
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Address Line | PO BOX 221788
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City | SACRAMENTO
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State | CA
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Zip | 95822-8788
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Country | US
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Telephone | 312-722-2683
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Fax | 312-275-7549
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A144347
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A144347
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License Number State | CA
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