Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 20A9731 | CA |
NPI | 1205929270 |
---|---|
Provider Name | Tracy Marla Skolnick |
First Address | Newcastle, CA 95658-9421 |
Second Address | Newcastle, CA 95658-9421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H05437 | (02) | PA |