=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275797466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER J CHOATE MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2008
-----------------------------------------------------
Last Update Date | 08/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3035 N MAIN ST
-----------------------------------------------------
City | SOQUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95073-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-462-8750
-----------------------------------------------------
Fax | 831-475-5713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3035 N MAIN ST
-----------------------------------------------------
City | SOQUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95073-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-462-8750
-----------------------------------------------------
Fax | 831-475-5713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | VICKY MEADOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-462-8755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinic/Center
-----------------------------------------------------
License Number | G591170
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------