Provider Demographics
NPI:1457943219
Name:MENEZES, SHIMONA BREZIL
Entity Type:Individual
Prefix:
First Name:SHIMONA
Middle Name:BREZIL
Last Name:MENEZES
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 1:1930 N PLACENTIA AVE # 819
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1522
Mailing Address - Country:US
Mailing Address - Phone:714-792-0990
Mailing Address - Fax:
Practice Address - Street 1:1930 N PLACENTIA AVE # 819
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1522
Practice Address - Country:US
Practice Address - Phone:714-792-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist