MEDICARE: MRS. CLORINDA N T SHORES PA

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	363A00000X	Physician Assistant	PA16549	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA16549	OTHER	CA	PHYSICIAN ASSISTANT

General Provider Information

NPI Number	:	1689885931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLORINDA N T SHORES PA

Provider Business Mailing Address
First Line	:	PO BOX 788
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92546-0788
Country	:	US
Telephone Number	:	951-652-0060
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 N GILBERT ST BLDG B4
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-4078
Country	:	US
Telephone Number	:	951-652-0060
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	03/06/2018

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