Provider Demographics
NPI:1881856649
Name:NATHAN, SHIRLYNN (ABOC)
Entity Type:Individual
Prefix:
First Name:SHIRLYNN
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 E PLAZA BLVD STE D5
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3676
Mailing Address - Country:US
Mailing Address - Phone:619-336-0566
Mailing Address - Fax:619-336-0567
Practice Address - Street 1:1420 E PLAZA BLVD STE D5
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3676
Practice Address - Country:US
Practice Address - Phone:619-336-0566
Practice Address - Fax:619-336-0567
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL5873156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician