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Individual

DEJA SHOLK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
787 RIVERSIDE DR, UKIAH, CA 95482-9606
(951) 385-9359
Mailing address
510 STEWART ST, FORT BRAGG, CA 95437-3207

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D1314463
CA

Other

Enumeration date
09/29/2022
Last updated
09/29/2022
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