MEDICARE: MRS. SAMRANG SUON SCHIMELPFENIG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	504773	CA

General Provider Information

NPI Number	:	1174644157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMRANG SUON SCHIMELPFENIG NP

Provider Business Mailing Address
First Line	:	4660 EL CAJON BLVD
Second Line	:	212
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4450
Country	:	US
Telephone Number	:	619-563-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 EL CAJON BLVD
Second Line	:	212
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4450
Country	:	US
Telephone Number	:	619-563-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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