Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 55193 | CA |
NPI | 1215442991 |
---|---|
Provider Name | Soquel Schafer |
First Address | San Luis Obispo, CA 93406-3026 |
Second Address | San Luis Obispo, CA 93405-1812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2017 |
Last Update Date | 04/12/2017 |