Healthcare Provider Details

I. General information

NPI: 1629486006
Provider Name (Legal Business Name): ELIZABETH F SCHAUT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 LANDIS AVE STE 300
CHULA VISTA CA
91910-2650
US

IV. Provider business mailing address

256 LANDIS AVE STE 300
CHULA VISTA CA
91910-2650
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-9600
  • Fax:
Mailing address:
  • Phone: 619-426-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3355-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA54293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: