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NPI Code Detail

MEDICARE: SHAWN COUCH

MEDICARE: SHAWN COUCH
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
1174400000XSpecialist

General Provider Information

NPI Number : 1548637705
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN COUCH
Provider Business Mailing Address
First Line : 7200 BANCROFT AVE STE 133
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2480
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7200 BANCROFT AVE STE 133
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2480
Country : US
Telephone Number : 510-553-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 08/24/2015

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Directions to “ SHAWN COUCH ” Practice Location

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