| Doctor Name: | RODERICK EMMANUEL SHANER |
| NPI Number: | 1669560181 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G34438 |
| Business Practice Address: | 550 S Vermont Ave Los Angeles, CA - 900201912 |
| Business Phone Number: | 2137384603 |
| Business Fax Number: | 2133861297 |
| Mailing Address: | 550 S Vermont Ave, LOS ANGELES |
| State: | CA |
| Postal Code: | 900201912 |
| Phone Number: | 2137384603 |
| Fax Number: | 2133861297 |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | G34438 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |