Provider Demographics
NPI:1497296438
Name:SHINMOTO, JOYCLYN (CP, BOCO)
Entity Type:Individual
Prefix:
First Name:JOYCLYN
Middle Name:
Last Name:SHINMOTO
Suffix:
Gender:F
Credentials:CP, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 LONE TREE WAY
Mailing Address - Street 2:STE. A & B
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8644
Mailing Address - Country:US
Mailing Address - Phone:925-754-1804
Mailing Address - Fax:
Practice Address - Street 1:4849 LONE TREE WAY
Practice Address - Street 2:STE. A & B
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8644
Practice Address - Country:US
Practice Address - Phone:925-754-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist