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NPI Code Detail

MEDICARE: MAKAILA SHANNON

MEDICARE: MAKAILA SHANNON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1790503092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKAILA SHANNON
Provider Business Mailing Address
First Line : 119 W TORRANCE BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3600
Country : US
Telephone Number : 310-374-3300
Fax Number : 310-374-3307
Provider Business Practice Location Address
First Line : 3280 MOTOR AVE STE 110
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3766
Country : US
Telephone Number : 424-672-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2024
Last Update Date : 10/13/2025

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Directions to “ MAKAILA SHANNON ” Practice Location

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