Provider Demographics
NPI:1194731505
Name:SHINN, GLORIA (L AC)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:SHINN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6025
Mailing Address - Country:US
Mailing Address - Phone:510-351-2833
Mailing Address - Fax:510-351-8308
Practice Address - Street 1:2186 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-6025
Practice Address - Country:US
Practice Address - Phone:510-351-2833
Practice Address - Fax:510-351-8308
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist