Healthcare Provider Details

I. General information

NPI: 1740226703
Provider Name (Legal Business Name): SHELLEY C GATH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W DUARTE RD STE 5
ARCADIA CA
91007-7365
US

IV. Provider business mailing address

PO BOX 661345
ARCADIA CA
91066-1345
US

V. Phone/Fax

Practice location:
  • Phone: 626-538-4505
  • Fax: 877-320-3170
Mailing address:
  • Phone: 626-538-4505
  • Fax: 877-320-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4259
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: