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NPI Code Detail

MEDICARE: WILLIAM WALTER SHELTON SUDCC III, 16157

MEDICARE: WILLIAM WALTER SHELTON SUDCC III, 16157
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 ProgramCA
2101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1649661232
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM WALTER SHELTON SUDCC III, 16157
Provider Business Mailing Address
First Line : 11015 BLOOMFIELD AVE
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-4601
Country : US
Telephone Number : 562-906-2676
Fax Number :
Provider Business Practice Location Address
First Line : 9300 SANTA FE SPRINGS RD
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-2621
Country : US
Telephone Number : 562-906-2676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2015
Last Update Date : 10/06/2025

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