Provider Demographics
NPI:1922453919
Name:SHIMONI, KEREN
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:SHIMONI
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 1:1000 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90747-0001
Mailing Address - Country:US
Mailing Address - Phone:949-274-9908
Mailing Address - Fax:
Practice Address - Street 1:1000 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90747-4325
Practice Address - Country:US
Practice Address - Phone:949-274-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist