Healthcare Provider Details

I. General information

NPI: 1033201256
Provider Name (Legal Business Name): TINA FATIN SCOBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

IV. Provider business mailing address

PO BOX 10000
PALO ALTO CA
94303-0985
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA45620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: