Provider Demographics
NPI:1689434656
Name:GARNER, SHAQUILLE MARQUAN
Entity Type:Individual
Prefix:
First Name:SHAQUILLE
Middle Name:MARQUAN
Last Name:GARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 CAMINITO ESTRELLADO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3023
Mailing Address - Country:US
Mailing Address - Phone:662-317-9880
Mailing Address - Fax:
Practice Address - Street 1:17050 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-2806
Practice Address - Country:US
Practice Address - Phone:951-697-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist