Healthcare Provider Details

I. General information

NPI: 1770798282
Provider Name (Legal Business Name): R. ANDREW SCHULTZ-ROSS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 CEREDA LN
FAIRFIELD CA
94534-1561
US

IV. Provider business mailing address

PO BOX 1918
TRAVIS AFB CA
94535-0918
US

V. Phone/Fax

Practice location:
  • Phone: 808-936-2899
  • Fax:
Mailing address:
  • Phone: 808-936-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD7875
License Number StateHI

VIII. Authorized Official

Name: DR. ROY ANDREW SCHULTZ-ROSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-936-2899