Provider Demographics
NPI:1477503886
Name:SHAW, HONORATA GALIT (CRNFA, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HONORATA
Middle Name:GALIT
Last Name:SHAW
Suffix:
Gender:F
Credentials:CRNFA, NP-C
Other - Prefix:MRS
Other - First Name:NORA
Other - Middle Name:GALIT
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-782-3859
Mailing Address - Fax:951-780-8196
Practice Address - Street 1:7160 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2614
Practice Address - Country:US
Practice Address - Phone:951-782-3859
Practice Address - Fax:951-332-8260
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ04123ZMedicare UPIN