Healthcare Provider Details

I. General information

NPI: 1851801237
Provider Name (Legal Business Name): BROCK K SCHMID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 TELEGRAPH AVE
BERKELEY CA
94705-1117
US

IV. Provider business mailing address

5900 3RD ST UNIT 2413
SAN FRANCISCO CA
94124-3158
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax:
Mailing address:
  • Phone: 810-335-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: