Provider Demographics
NPI:1417575051
Name:CANINO, SHELBY ANN (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:ANN
Last Name:CANINO
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10985 AUTILLO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1315
Mailing Address - Country:US
Mailing Address - Phone:858-699-7332
Mailing Address - Fax:
Practice Address - Street 1:3255 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3806
Practice Address - Country:US
Practice Address - Phone:619-936-9311
Practice Address - Fax:858-715-6458
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA838326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse