Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 20A7407 | CA |
NPI | 1003286782 |
---|---|
Provider Name | Dr. Shawn Kristian Centers |
First Address | San Diego, CA 92108-3263 |
Second Address | San Diego, CA 92123-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2015 |
Last Update Date | 07/10/2015 |