MEDICARE: JAMES SHOFFEITT

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1093252207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SHOFFEITT

Provider Business Mailing Address
First Line	:	34244 VIA SANTA ROSA
Second Line	:	SUITE A
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34244 VIA SANTA ROSA
Second Line	:	SUITE A
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1121
Country	:	US
Telephone Number	:	760-625-4320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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