Provider Demographics
NPI:1952081408
Name:ABENOJAR, SHAINA GARCIA
Entity type:Individual
Prefix:MRS
First Name:SHAINA
Middle Name:GARCIA
Last Name:ABENOJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7844 AROSIA DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4044
Mailing Address - Country:US
Mailing Address - Phone:909-609-1894
Mailing Address - Fax:
Practice Address - Street 1:1880 N ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3006
Practice Address - Country:US
Practice Address - Phone:909-630-7158
Practice Address - Fax:909-398-0260
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily