MEDICARE: DR. MYRON SCHONBRUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G12482	CA

General Provider Information

NPI Number	:	1013992395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRON SCHONBRUN M.D.

Provider Business Mailing Address
First Line	:	2918 FIFTH AVE
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5910
Country	:	US
Telephone Number	:	619-688-0770
Fax Number	:	619-688-0987

Provider Business Practice Location Address
First Line	:	2918 FIFTH AVE
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5910
Country	:	US
Telephone Number	:	619-688-0770
Fax Number	:	619-688-0987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/31/2012

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