Provider Demographics
NPI:1174978332
Name:TOBAR, SHANNA (NMD)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:TOBAR
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2347
Mailing Address - Country:US
Mailing Address - Phone:858-829-2363
Mailing Address - Fax:
Practice Address - Street 1:15710 N 183RD DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2313
Practice Address - Country:US
Practice Address - Phone:858-829-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01-645175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath