Provider Demographics
NPI:1598129587
Name:CARBAJAL, SHANNON MARIE VALDEZ (MD)
Entity type:Individual
Prefix:
First Name:SHANNON MARIE
Middle Name:VALDEZ
Last Name:CARBAJAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26600 CACTUS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3901
Mailing Address - Country:US
Mailing Address - Phone:951-988-9500
Mailing Address - Fax:951-571-8938
Practice Address - Street 1:26600 CACTUS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3901
Practice Address - Country:US
Practice Address - Phone:951-988-9500
Practice Address - Fax:951-571-8938
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA157535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine