MEDICARE: TRACY MARLA SKOLNICK D.O.

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	20A9731	CA

General Provider Information

NPI Number	:	1205929270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY MARLA SKOLNICK D.O.

Provider Business Mailing Address
First Line	:	151 RAINBOW VALLEY LN
Second Line	:
City	:	NEWCASTLE
State	:	CA
Zip	:	95658-9421
Country	:	US
Telephone Number	:	916-276-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 RAINBOW VALLEY LN
Second Line	:
City	:	NEWCASTLE
State	:	CA
Zip	:	95658-9421
Country	:	US
Telephone Number	:	916-276-1389
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/25/2014

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