Provider Information for 1790244135
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Ms. SHANNAN A FAUST
Sex: Female
NPI: 1790244135
Last Updated: 2022-08-09
Certification Date: 2022-08-09
Certification Date: 2022-08-09
Details
| Name | Value | ||||||||||||||||
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| NPI | 1790244135 | ||||||||||||||||
| Enumeration Date | 2019-03-15 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 470 E 3RD ST STE C LOS ANGELES, CA 90013-1630 United States Phone: 213-620-5712 | Fax: | ||||||||||||||||
| Primary Practice Address | 470 E 3RD ST STE C LOS ANGELES, CA 90013 United States Phone: 213-620-5712 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 3230 E IMPERIAL HWY | ||||||||||||||||
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