Individual
SHANTE ERICA MEDEARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 955-4126
Mailing address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 955-4126
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-BDXHFQ
CA
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
01/27/2025
Last updated
06/23/2025
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