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NPI Code Detail

MEDICARE: SHOUA FANG BA

MEDICARE: SHOUA FANG BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1023131521
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOUA FANG BA
Provider Business Mailing Address
First Line : 6449 LANSTON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-6515
Country : US
Telephone Number : 858-205-3075
Fax Number :
Provider Business Practice Location Address
First Line : 5005 TEXAS ST STE 203
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3723
Country : US
Telephone Number : 619-692-0727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 07/08/2007

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Directions to “ SHOUA FANG BA” Practice Location

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