Healthcare Provider Details

I. General information

NPI: 1942360755
Provider Name (Legal Business Name): J RANDOLPH SCHNITMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR LOWER LEVEL 1
BEVERLY HILLS CA
90210-4321
US

IV. Provider business mailing address

435 NORTH BEDFORD DRIVE LOWER LEVEL 1
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-5432
  • Fax: 310-275-5434
Mailing address:
  • Phone: 310-275-5432
  • Fax: 310-275-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG62430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: