MEDICARE: KATIE MELODY SHUBIN PA-C

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	363AM0700X	Medical Physician Assistant	PA18171	CA

General Provider Information

NPI Number	:	1538196837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MELODY SHUBIN PA-C

Provider Business Mailing Address
First Line	:	3545 LONG BEACH BLVD
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3941
Country	:	US
Telephone Number	:	562-595-0060
Fax Number	:	562-981-0916

Provider Business Practice Location Address
First Line	:	3545 LONG BEACH BLVD
Second Line	:	SUITE 105
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3941
Country	:	US
Telephone Number	:	562-595-0060
Fax Number	:	562-981-0916

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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