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General NPI Number Information
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NPI Number | 1932632502
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Entity Type | Individual
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Provider Name | SHANE COLLINS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 12301 WILSHIRE BLVD STE 210
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City | LOS ANGELES
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State | CA
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Zip | 90025-1000
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Country | US
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Telephone | 844-867-8444
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Fax | 424-538-4495
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Provider Business Mailing Address
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Address Line | 360 POST ST STE 500
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4908
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Country | US
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Telephone | 844-867-8444
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A173833
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License Number State | CA
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