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NPI Code Detail

MEDICARE: SHANNON FERGUSON

MEDICARE: SHANNON FERGUSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1619096674
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON FERGUSON
Provider Business Mailing Address
First Line : 1325 N WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5615
Country : US
Telephone Number : 323-461-3131
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5615
Country : US
Telephone Number : 323-461-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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Directions to “ SHANNON FERGUSON ” Practice Location

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