Provider Demographics
NPI:1871261610
Name:DORANTES, SHAWNDA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:MARIE
Last Name:DORANTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25711 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-8639
Mailing Address - Country:US
Mailing Address - Phone:760-877-8747
Mailing Address - Fax:
Practice Address - Street 1:137 S LAS POSAS RD STE 255
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2470
Practice Address - Country:US
Practice Address - Phone:760-877-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95018195163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice