Individual
MARTELL DA'SHAWN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
174 E 59TH ST, LONG BEACH, CA 90805-3468
(562) 841-7378
Mailing address
174 E 59TH ST, LONG BEACH, CA 90805-3468
(562) 841-7378
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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