Provider Demographics
NPI:1689278384
Name:SCHLOM, MAHALA CHANTA
Entity Type:Individual
Prefix:
First Name:MAHALA
Middle Name:CHANTA
Last Name:SCHLOM
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 1:8131 SHELDON RD APT 207
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1274
Mailing Address - Country:US
Mailing Address - Phone:916-643-5475
Mailing Address - Fax:
Practice Address - Street 1:8131 SHELDON RD APT 207
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1274
Practice Address - Country:US
Practice Address - Phone:916-643-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209296164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse