Individual
SHAWNA MARIE ACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
Mailing address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41283
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167G00000X
—
CA
Enumeration date
05/09/2019
Last updated
05/09/2019
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