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NPI Code Detail

MEDICARE: LOIS CARTER-SHAW

MEDICARE: LOIS CARTER-SHAW
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
1175T00000XPeer SpecialistMPSS-VNMTRXCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101YA0400XOTHERCABEHAVIORAL HEALTH AND SOCIAL SERVICES PROVIDER

General Provider Information

NPI Number : 1629403829
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOIS CARTER-SHAW
Provider Business Mailing Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number : 209-479-5429
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2013
Last Update Date : 10/02/2023

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Directions to “ LOIS CARTER-SHAW ” Practice Location

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