Individual
SCOTT KEVIN ISHMAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1350 BROADSTONE PKWY, APPT 3622, FOLSOM, CA 95630-8478
(530) 409-5755
Mailing address
1350 BROADSTONE PKWY, APPT 3622, FOLSOM, CA 95630-8478
(530) 409-5755
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA18592
CA
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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