Angela Shattles-Breedlove

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

365530141 Issued in CA

Practice address

13001 Walnut Way
Victorville, CA 92392-5542

Phone

(769) 953-5286

NPI assigned

Nov 6, 2023

Last updated

Nov 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Desert Horizon Residential Care

  • Assisted Living Facility
  • Victorville, CA
  • NPI 1164045803
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1902679509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13001 WALNUT WAY",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923925542",
            "telephone_number": "760-953-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13001 WALNUT WAY",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923925542",
            "telephone_number": "769-953-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTLES-BREEDLOVE",
        "first_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "365530141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanity Shannon
• Akhil Sharma, M.D.
• Anupama Sharma, MD
• Goldy Sharma, PA-C
• Erma Trena Jean Sharp-Davis
• John Stanley Shaver, D.D.S.
• Robert E. Shaw, D.D.S.
• Ronald Steven Shaw, D.C.
• Sheila Cherian MD PC
• Sheila M. Bartlett a Professional Corporation (Advanced Optometric Eyecare)

• Assisted Living Facility in Victorville, CA
• Providers in Victorville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.