Doctor Name: | SHELTON R HINES |
NPI Number: | 1003006990 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A69170 |
Business Practice Address: | 5300 Beach Blvd Ste 110 Suite 308 Buena Park, CA - 906211292 |
Business Phone Number: | 7143296497 |
Business Fax Number: | |
Mailing Address: | 5300 Beach Blvd Ste 110, Suite 308 BUENA PARK |
State: | CA |
Postal Code: | 906211292 |
Phone Number: | 7143296497 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2007 |
NPI Last Update Date: | 07/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A69170 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |