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NPI Code Detail

MEDICARE: MRS. STEPHANIE CAVALLO

MEDICARE: MRS. STEPHANIE CAVALLO
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
1183500000XPharmacist48870CA

General Provider Information

NPI Number : 1205247053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE CAVALLO
Provider Business Mailing Address
First Line : 950 CODDINGTOWN CTR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-3512
Country : US
Telephone Number : 707-596-5588
Fax Number : 707-596-5598
Provider Business Practice Location Address
First Line : 950 CODDINGTOWN CTR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-3512
Country : US
Telephone Number : 707-596-5588
Fax Number : 707-596-5598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2014
Last Update Date : 02/21/2020

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Directions to “ MRS. STEPHANIE CAVALLO ” Practice Location

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