Provider Demographics
NPI:1093230757
Name:SHIRONAKA, GLENN HIROAKI
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:HIROAKI
Last Name:SHIRONAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7771 SLEEPY RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4482
Mailing Address - Country:US
Mailing Address - Phone:916-346-7030
Mailing Address - Fax:
Practice Address - Street 1:7771 SLEEPY RIVER WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-4482
Practice Address - Country:US
Practice Address - Phone:916-346-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician