Individual
MR. MARK A SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BC-HIS
Contact information
Practice address
925 E PENNSYLVANIA AVENUE, SUITE H, ESCONDIDO, CA 92025
(760) 743-5544
(760) 743-5306
Mailing address
925 E PENNSYLVANIA AVENUE, SUITE H, ESCONDIDO, CA 92025
(760) 743-5544
(760) 743-5306
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA531
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194897496
MEDI-CAL
CA
Enumeration date
05/18/2011
Last updated
03/24/2017
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