SHANE WALLIN


Address: 1968 Garnet Ave, San Diego, CA 92109-3555
Phone: 6122141325

SHANE WALLIN (NPI# 1104282177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

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

Provider Secondary Practice Location

Address Telephone Number Fax Number
4933 34th Ave S, Minneapolis, MN 554171503 6199429737
9425 Syndicate Ave, Bloomington, MN 554202773 6122141325

Other Providers SHANE WALLIN

NPI Name Taxonomy Address Enumeration
1326243221 Shane Robert Wallin Social Worker 2275 Arlington Dr, San Leandro, CA 94578-1132 2007-06-19

Office Location

Street Address 1968 GARNET AVE
City SAN DIEGO
State CA
Zip Code 92109-3555

Providers in the same location

NPI Name Taxonomy Address Enumeration
1194181602 Garnet Tattoo Specialist/Technologist, Other 1968 Garnet Ave, San Diego, CA 92109-3555 2016-01-13

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 246ZA2600X
Grouping Technologists, Technicians & Other Technical Service Providers
Classification Specialist/Technologist, Other
Specialization Art, Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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
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Competitor

Search similar providers

City SAN DIEGO
Zip Code 92109

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Dataset Information

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.

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