Provider Demographics
NPI:1750768115
Name:BUSSEY, SHAUNTIS L
Entity type:Individual
Prefix:
First Name:SHAUNTIS
Middle Name:L
Last Name:BUSSEY
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 1:39520 MURRIETA HOT SPRINGS RD STE 219-2002
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39520 MURRIETA HOT SPRINGS RD STE 219-2002
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7713
Practice Address - Country:US
Practice Address - Phone:760-573-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program