1689093072 NPI number — MRS. SHAUNA LEE ANN BESSETTE M.S.

Table of content: MRS. SHAUNA LEE ANN BESSETTE M.S. (NPI 1689093072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689093072 NPI number — MRS. SHAUNA LEE ANN BESSETTE M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESSETTE
Provider First Name:
SHAUNA
Provider Middle Name:
LEE ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTIS
Provider Other First Name:
SHAUNA
Provider Other Middle Name:
LEE-ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689093072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3903 CONRAD DR APT 64
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91977-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-680-6227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 CAMINO DEL RIO S STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-270-5622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  IMF 73691 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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