Provider Demographics
NPI:1376228015
Name:PEPITO, KAE ANNA MAYE SOCO
Entity Type:Individual
Prefix:
First Name:KAE ANNA MAYE
Middle Name:SOCO
Last Name:PEPITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 PETALUMA CT
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5940
Mailing Address - Country:US
Mailing Address - Phone:831-537-6694
Mailing Address - Fax:
Practice Address - Street 1:1651 PETALUMA CT
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5940
Practice Address - Country:US
Practice Address - Phone:831-537-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61449800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse