MEDICARE: DR. SHANICKA N SCARBROUGH M.D.

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
1	207Q00000X	Family Medicine Physician	A144347	CA
2	208D00000X	General Practice Physician	A144347	CA

General Provider Information

NPI Number	:	1639307895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANICKA N SCARBROUGH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 221788
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-8788
Country	:	US
Telephone Number	:	312-722-2683
Fax Number	:	312-275-7549

Provider Business Practice Location Address
First Line	:	3746 FOOTHILL BLVD # B140
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1740
Country	:	US
Telephone Number	:	310-445-5999
Fax Number	:	323-544-4248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	11/21/2024

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