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Individual

TRACIE SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DPM

Contact information

Practice address
5365 WALNUT AVE STE P, CHINO, CA 91710-2622
(909) 946-6643
Mailing address
1039 S INDIAN SUMMER AVE, WEST COVINA, CA 91790-5216
(626) 660-5239

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5975
CA

Other

Enumeration date
06/09/2021
Last updated
08/13/2024
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