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NPI Code Detail

MEDICARE: SHIRLEY DIFUNTORUM

MEDICARE: SHIRLEY DIFUNTORUM
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
12279C0205XCritical Care Registered Respiratory Therapist27728CA

General Provider Information

NPI Number : 1821568015
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY DIFUNTORUM
Provider Business Mailing Address
First Line : 6425 NOBLE HOUSE CT
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-4351
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6600 BRUCEVILLE RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-4671
Country : US
Telephone Number : 916-688-6305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2018
Last Update Date : 12/04/2018

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Directions to “ SHIRLEY DIFUNTORUM ” Practice Location

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