Most Relevant Information
Provider Data
| NPI Number: | 1003433368 |
| Provider Name: | SHANNON ASHLY REQUENA |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/01/2020 |
| Last Updated: | 07/01/2020 |
Provider Practice Location
550 S VERMONT AVE
LOS ANGELES
CA
900201912
Practice Location Phone/Fax
| Phone: | 2137633161 |
| Fax: |
Provider Mailing Location
550 S VERMONT AVE
LOS ANGELES
CA
900201912
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |