Most Relevant Information
Provider Data
| NPI Number: | 1003527417 |
| Provider Name: | SHELLEY RAE VAN GUNDY OCONNOR |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/06/2022 |
| Last Updated: | 12/06/2022 |
Provider Practice Location
2227 CAPRICORN WAY STE 201
SANTA ROSA
CA
954075478
Practice Location Phone/Fax
| Phone: | 7075654854 |
| Fax: |
Provider Mailing Location
2227 CAPRICORN WAY STE 201
SANTA ROSA
CA
954075478
Provider Mailing Phone/Fax
| Phone: | 7075654854 |
| Fax: |