Provider Demographics
NPI:1497219208
Name:SHIGENAKA, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SHIGENAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4964 KLUSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1631
Mailing Address - Country:US
Mailing Address - Phone:909-996-4509
Mailing Address - Fax:
Practice Address - Street 1:4964 KLUSMAN AVENUE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737
Practice Address - Country:US
Practice Address - Phone:909-996-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70701101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor