Individual
MR. SHANE A FUTCHKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3930 4TH AVE, STE 200, SAN DIEGO, CA 92103-3119
(352) 219-3271
Mailing address
3930 4TH AVE, STE 200, SAN DIEGO, CA 92103-3119
(352) 219-3271
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21690
CA
Other
Enumeration date
02/01/2008
Last updated
07/27/2012
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