Provider Demographics
NPI:1295177699
Name:NEWSON, SHIRELL TIFFANY (CSCM)
Entity Type:Individual
Prefix:
First Name:SHIRELL
Middle Name:TIFFANY
Last Name:NEWSON
Suffix:
Gender:F
Credentials:CSCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 SANTA FE AVE E
Mailing Address - Street 2:APT E 45
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7968
Mailing Address - Country:US
Mailing Address - Phone:760-669-9707
Mailing Address - Fax:760-851-0995
Practice Address - Street 1:9055 SANTA FE AVE E
Practice Address - Street 2:APT E 45
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-7968
Practice Address - Country:US
Practice Address - Phone:760-669-9707
Practice Address - Fax:760-851-0995
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X, 251E00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-2346304Medicaid