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NPI Code Detail

MEDICARE: MADELINE STROM

MEDICARE: MADELINE STROM
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
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1518667708
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE STROM
Provider Business Mailing Address
First Line : 7460 SARAVIEW WAY
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-4716
Country : US
Telephone Number : 707-889-1875
Fax Number :
Provider Business Practice Location Address
First Line : 5500 CAMPANILE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92182-0003
Country : US
Telephone Number : 619-594-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2023
Last Update Date : 03/06/2023

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Directions to “ MADELINE STROM ” Practice Location

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