Provider Demographics
NPI:1821456617
Name:SHINN, JOAQUINA
Entity Type:Individual
Prefix:
First Name:JOAQUINA
Middle Name:
Last Name:SHINN
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 1:3920 EAGLE ROCK BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3668
Mailing Address - Country:US
Mailing Address - Phone:323-474-6070
Mailing Address - Fax:323-474-6066
Practice Address - Street 1:3920 EAGLE ROCK BLVD STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3668
Practice Address - Country:US
Practice Address - Phone:323-474-6070
Practice Address - Fax:323-474-6066
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47-4026640OtherORGANIZATION