Provider Demographics
NPI:1225797855
Name:CACHO, SHENA UNSOO (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:SHENA
Middle Name:UNSOO
Last Name:CACHO
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 VALLEJO MILLS ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2939
Mailing Address - Country:US
Mailing Address - Phone:858-354-6705
Mailing Address - Fax:
Practice Address - Street 1:5630 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:619-236-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561785163WC1400X
CA796201163WX0200X
CA95199887163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology