Provider Demographics
NPI:1245590124
Name:SHUCKETT, ARIEL (MD, MPH, MA)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:SHUCKETT
Suffix:
Gender:F
Credentials:MD, MPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-277-9378
Mailing Address - Fax:858-277-9378
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-9378
Practice Address - Fax:858-277-9378
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology