Basic Information
| Provider Information | |||||||||
| NPI: | 1760410625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHINAMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 MORELLO AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945231860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252871256 | ||||||||
| FaxNumber: | 9252870913 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 MORELLO AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945231860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252871256 | ||||||||
| FaxNumber: | 9252870913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | A76063 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | A76063 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A760630 | 05 | CA | MEDICAID |