Healthcare Provider Details

I. General information

NPI: 1902017833
Provider Name (Legal Business Name): MAUREEN SHEPARD CCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 I ST #2
SACRAMENTO CA
95816-4572
US

IV. Provider business mailing address

PO BOX 19594
SACRAMENTO CA
95819-0594
US

V. Phone/Fax

Practice location:
  • Phone: 916-397-6345
  • Fax:
Mailing address:
  • Phone: 916-397-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: