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NPI Code Detail

MEDICARE: SHANE MICHAEL HOEKWATER

MEDICARE:   SHANE MICHAEL HOEKWATER
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
1183700000XPharmacy Technician87306CA

General Provider Information

NPI Number : 1912249434
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE MICHAEL HOEKWATER
Provider Business Mailing Address
First Line : 4375 SAINT CHARLES PL
Second Line :
City : CONCORD
State : CA
Zip : 94521-3458
Country : US
Telephone Number : 925-899-2814
Fax Number :
Provider Business Practice Location Address
First Line : 4375 SAINT CHARLES PL
Second Line :
City : CONCORD
State : CA
Zip : 94521-3458
Country : US
Telephone Number : 925-899-2814
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2013
Last Update Date : 03/22/2013

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Directions to “ SHANE MICHAEL HOEKWATER ” Practice Location

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