Individual
MS. CHONDRA ELISE SHANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
665 N D ST, SAN BERNARDINO, CA 92401-1109
(909) 708-8158
Mailing address
665 N D ST, SAN BERNARDINO, CA 92401-1109
(909) 708-8158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
21231
CA
Other
Enumeration date
10/15/2010
Last updated
05/08/2013
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