Provider Demographics
NPI:1194535526
Name:DIAL, SHAUN RICHARD
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:RICHARD
Last Name:DIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 RAMADA WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-6979
Mailing Address - Country:US
Mailing Address - Phone:714-349-5623
Mailing Address - Fax:
Practice Address - Street 1:970 RAMADA WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-6979
Practice Address - Country:US
Practice Address - Phone:714-349-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB00003600924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)