Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A26737 | CA |
NPI | 1598873572 |
---|---|
Provider Name | Marie D Schafle |
First Address | Angels Camp, CA 95222-9744 |
Second Address | Angels Camp, CA 95222-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |