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NPI Code Detail

MEDICARE: MR. SHANE LENRE CALAGUAS AVILA NP

MEDICARE:  MR. SHANE LENRE CALAGUAS AVILA  NP
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
1363LA2200XAdult Health Nurse Practitioner95000320CA
2363LG0600XGerontology Nurse Practitioner95000320CA
3363L00000XNurse Practitioner95000320CA

General Provider Information

NPI Number : 1740607167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHANE LENRE CALAGUAS AVILA NP
Provider Business Mailing Address
First Line : 22734 MONETA AVE
Second Line :
City : CARSON
State : CA
Zip : 90745-3601
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 4910 AIRPORT PLAZA DR STE 100
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1377
Country : US
Telephone Number : 562-429-2473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2014
Last Update Date : 03/06/2026

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