Provider Information for 1174159214
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SHAAKIRA MCMILLON
Sex: Female
NPI: 1174159214
Last Updated: 2020-03-24
Certification Date: 2020-03-24
Certification Date: 2020-03-24
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174159214 | ||||||||
| Enumeration Date | 2020-03-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1825 GALINDO ST APT 326 CONCORD, CA 94520-2785 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1855 4TH ST SAN FRANCISCO, CA 94143-2350 United States Phone: 661-319-2320 | Fax: | ||||||||
| Secondary Practice Address(es) | 1825 GALINDO ST APT 326 | ||||||||
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