Individual
JONTIA SHALLOWHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26929 NUCIA DR, MORENO VALLEY, CA 92555-4983
(661) 492-4743
Mailing address
26929 NUCIA DR, MORENO VALLEY, CA 92555-4983
(661) 492-4743
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
B9256240
CA
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B9256240
CALIFORNIA DRIVER'S LICENSE
CA
Enumeration date
09/29/2019
Last updated
04/02/2026
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