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NPI Code Detail

MEDICARE: MR. SHANE DALE MULLIKIN

MEDICARE: MR. SHANE DALE MULLIKIN
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
1171400000XHealth & Wellness CoachCA
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1669816476
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHANE DALE MULLIKIN
Provider Business Mailing Address
First Line : 12555 NAVAJO RD
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92308-7256
Country : US
Telephone Number : 760-247-8001
Fax Number :
Provider Business Practice Location Address
First Line : 12555 NAVAJO RD
Second Line :
City : APPLE VALLEY
State : CA
Zip : 92308-7256
Country : US
Telephone Number : 760-247-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2013
Last Update Date : 01/08/2026

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Directions to “ MR. SHANE DALE MULLIKIN ” Practice Location

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