MEDICARE: MRS. CLAUDIA BETH FAGILDE 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	363LA2200X	Adult Health Nurse Practitioner	NP 5510	CA
2	363LW0102X	Women's Health Nurse Practitioner	NP5510	CA
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	NP 5510	CA

General Provider Information

NPI Number	:	1780795021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLAUDIA BETH FAGILDE NP

Provider Business Mailing Address
First Line	:	1691 THE ALAMEDA
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2203
Country	:	US
Telephone Number	:	408-287-7532
Fax Number	:	408-287-0405

Provider Business Practice Location Address
First Line	:	678 N WILSON WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-4272
Country	:	US
Telephone Number	:	209-446-2081
Fax Number	:	209-466-2083

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/25/2007

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