Individual
SHINY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1030 NEVADA ST, REDLANDS, CA 92374-2957
(909) 553-0055
Mailing address
5360 CORISON WAY, FONTANA, CA 92336-5995
(909) 553-0055
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95028911
CA
Other
Enumeration date
04/05/2024
Last updated
04/05/2024
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