Provider Demographics
NPI:1528827755
Name:ANDERSEN, SHIRLEY ANN (RCP 111)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:RCP 111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2321
Mailing Address - Country:US
Mailing Address - Phone:825-358-3885
Mailing Address - Fax:
Practice Address - Street 1:6640 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3734
Practice Address - Country:US
Practice Address - Phone:949-932-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74682278P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function Technologist