Individual
CHARLEYNE KHAMASI-SOOMALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 E 15TH ST, MERCED, CA 95341-6217
(209) 381-7879
(209) 725-3775
Mailing address
PO BOX 2087, MERCED, CA 95344-0087
(209) 381-7879
(209) 725-3775
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95063658
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013030808
—
CA
Enumeration date
05/06/2016
Last updated
05/06/2016
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