SHANE WALLIN (NPI# 1104282177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104282177 |
Entity Type | Individual |
Full Name | SHANE WALLIN |
Practice Address |
1968 Garnet Ave San Diego CA 92109-3555 |
Mailing Address |
3116 Mooney St San Diego CA 92117-6137 |
Practice Telephone | 6122141325 |
Mailing Telephone | 6199429737 |
Enumeration Date | 2016-01-06 |
Last Update Date | 2019-08-07 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 246ZA2600X |
Specialist/Technologist, Other Specialization: Art, Medical |
310143 | MN | Technologists, Technicians & Other Technical Service Providers |
Address | Telephone Number | Fax Number |
---|---|---|
4933 34th Ave S, Minneapolis, MN 554171503 | 6199429737 | |
9425 Syndicate Ave, Bloomington, MN 554202773 | 6122141325 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326243221 | Shane Robert Wallin | Social Worker | 2275 Arlington Dr, San Leandro, CA 94578-1132 | 2007-06-19 |
Street Address |
1968 GARNET AVE |
City | SAN DIEGO |
State | CA |
Zip Code | 92109-3555 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194181602 | Garnet Tattoo | Specialist/Technologist, Other | 1968 Garnet Ave, San Diego, CA 92109-3555 | 2016-01-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538620786 | San Diego Forensic Psychology Corporation | Psychologist | 4640 Cass Street, # 90422, San Diego, CA 92109 | 2019-03-29 |
1982113874 | Holly Mansur | Registered Nurse | 3663 Jewell Street, San Diego, CA 92109 | 2017-09-24 |
1669906178 | Kelley Ann Riley | Prevention Professional | 4328 Gresham St, San Diego, CA 92109 | 2017-04-12 |
1689113524 | Tyler Marquis | Pharmacist | 2636 Grand Avenue Apartment 326, San Diego, CA 92109 | 2017-02-13 |
1912372574 | Lonnie Butler | Doula | 841 Turquoise Street, F-405, San Diego, CA 92109 | 2015-12-08 |
1275924995 | Pratima S. Gowdar, Dds, Inc | Dentist | 4655 Cass St. Ste 104, San Diego, CA 92109 | 2015-02-17 |
1417388562 | Pacific Rim Pathology Medical Corporation | Clinical Medical Laboratory | 3030 Bunker Hill Street, Suite 201, San Diego, CA 92109 | 2013-11-27 |
1023379997 | Eric Berquist | Student in an Organized Health Care Education/Training Program | 2009 Reed Ave, San Diego, CA 92109 | 2012-06-06 |
1982996724 | Miramar Health Physicians Group | Acupuncturist | 1321 Garnet Avenue, San Diego, CA 92109 | 2011-05-12 |
1902109325 | Anna N Amagou | Behavioral Analyst | 2221 Felspar Street Apt #c, San Diego, CA 92109 | 2010-12-07 |
Find all providers in zip 92109 |
Taxonomy Code | 246ZA2600X |
Grouping | Technologists, Technicians & Other Technical Service Providers |
Classification | Specialist/Technologist, Other |
Specialization | Art, Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093987661 | Natalie Javae Turner | Specialist/Technologist, Other | 4520 51st St Apt 9, San Diego, CA 92115-3462 | 2008-03-24 |
1194181602 | Garnet Tattoo | Specialist/Technologist, Other | 1968 Garnet Ave, San Diego, CA 92109-3555 | 2016-01-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841809621 | Diane Vincent Sharp | Specialist/Technologist, Other | 180 Leveland Ln Ste 1b, Modesto, CA 95350-2254 | 2020-07-28 |
1235791161 | Heidi Henderson | Specialist/Technologist, Other | 10606 Hageman Rd Ste B4, Bakersfield, CA 93312-9109 | 2019-07-01 |
1801304621 | Id Acupuncture | Specialist/Technologist, Other | 13851 E 14th St Ste 203, San Leandro, CA 94578-2627 | 2018-01-15 |
1528574084 | Laura Becker | Specialist/Technologist, Other | 1155 Palm Ave, Imperial Beach, Imperial Beach, CA 91932-9193 | 2017-12-20 |
1225583073 | Kathleen Mcgraw | Specialist/Technologist, Other | 25030 Avenue Stanford Ste 100, Valencia, CA 91355-4505 | 2016-08-22 |
1932555042 | Dawn Percer | Specialist/Technologist, Other | 29377 Rancho California Rd Ste 101, Temecula, CA 92591-5206 | 2016-05-06 |
1700286804 | Holly Feneht | Specialist/Technologist, Other | 21826 Grovepark Dr, Saugus, CA 91350-1616 | 2014-08-26 |
1285057273 | Restorative Ink Specialists | Specialist/Technologist, Other | 1218 Irvine Blvd # 13, Tustin, CA 92780-3531 | 2014-01-27 |
1750643664 | Shelley Marie Kohl | Specialist/Technologist, Other | 425 E. Center St Suite 1, Manteca, CA 95336 | 2012-06-15 |
1598045577 | Jill Hoyer | Specialist/Technologist, Other | 413b Monterey Ave, Los Gatos, CA 95030-5302 | 2011-08-23 |
Find all providers with the same taxonomy |
Please comment or provide details below to improve the information on SHANE WALLIN.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.