Organization
BRIT S SHACKLEY MD APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIT SHACKLEY MD (PRESIDENT)
(626) 397-5667
Entity
Organization
Contact information
Practice address
100 W CALIFORNIA BLVD, PASADENA, CA 91105-3010
(626) 397-5667
(626) 397-2156
Mailing address
100 W CALIFORNIA BLVD, PASADENA, CA 91105-3010
(626) 397-5667
(626) 397-2156
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
A107373
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A107373
CA MED LICENSE
CA
Enumeration date
08/15/2012
Last updated
08/15/2012
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