Individual
MS. SHANNA LA RHONDA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S HALE AVE SPC 54, ESCONDIDO, CA 92029-2177
(858) 729-8295
Mailing address
14298 CHANTRY DR, MORENO VALLEY, CA 92553-4946
(818) 224-9309
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B8422966
DRIVER LICENSE
—
Enumeration date
07/13/2022
Last updated
07/13/2022
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