Individual
KANAE SHAPUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5696 LAKE MURRAY BLVD, LA MESA, CA 91942-1929
(858) 829-8999
Mailing address
9131 MEADOWRUN CT, SAN DIEGO, CA 92129-3397
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
770674
CA
Other
Enumeration date
12/29/2017
Last updated
12/29/2017
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