| CH Specialty Services Ca PC | |
|
1031 Roseville Pkwy Roseville CA 95678-6279 | |
| (337) 408-0797 | |
| Not Available |
| Full Name | CH Specialty Services Ca PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1031 Roseville Pkwy, Roseville, California |
| Authorized Official Name and Position | Nicole Howard (SR VP OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 3374080797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| CH Specialty Services Ca PC 5750 Johnston St Ste 205 Lafayette LA 70503-5345 Ph: (337) 408-0797 | CH Specialty Services Ca PC 1031 Roseville Pkwy Roseville CA 95678-6279 Ph: (337) 408-0797 |
| NPI Number | 1730888041 |
|---|---|
| Provider Enumeration Date | 02/24/2023 |
| Last Update Date | 02/18/2025 |
| Certification Date | 02/18/2025 |
| Medicare PECOS PAC ID | 8820462203 |
|---|---|
| Medicare Enrollment ID | O20230327001060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730888041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Mark Daryl Canty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962573626 PECOS PAC ID: 0840180113 Enrollment ID: I20040318001601 |
| Provider Name | Jayson Weir |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1518257138 PECOS PAC ID: 2163647355 Enrollment ID: I20140701002282 |
| Provider Name | Timothy Puri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235458092 PECOS PAC ID: 8729261557 Enrollment ID: I20170925001934 |
| Provider Name | Jenny Singh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982180527 PECOS PAC ID: 5496097966 Enrollment ID: I20190502001511 |
| Provider Name | Tina a Shenouda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326386996 PECOS PAC ID: 9537397872 Enrollment ID: I20230404000647 |
| Provider Name | Brian Cooper |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366678963 PECOS PAC ID: 0547426223 Enrollment ID: I20230502001105 |
| Provider Name | Hilda M Defoe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235470402 PECOS PAC ID: 0446493191 Enrollment ID: I20240418003184 |
| Provider Name | Misty Lynn Pagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184119844 PECOS PAC ID: 4385996321 Enrollment ID: I20241203002599 |
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