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General NPI Number Information
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NPI Number | 1215442991
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Entity Type | Individual
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Provider Name | SOQUEL SCHAFER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 84 SANTA ROSA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1812
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Country | US
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Telephone | 805-591-4727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13026
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406-3026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 55193
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License Number State | CA
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