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General NPI Number Information
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NPI Number | 1750643664
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Entity Type | Individual
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Provider Name | SHELLEY MARIE KOHL C.P.C.P. CERT.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 425 E. CENTER ST SUITE 1
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City | MANTECA
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State | CA
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Zip | 95336
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Country | US
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Telephone | 209-456-7056
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Fax | 209-239-3033
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Provider Business Mailing Address
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Address Line | 425 E CENTER ST STE 1
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City | MANTECA
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State | CA
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Zip | 95336-4727
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Country | US
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Telephone | 209-456-7056
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Fax | 209-239-3033
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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 | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State |
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