Healthcare Provider Details

I. General information

NPI: 1134433253
Provider Name (Legal Business Name): ELLIOTT A. SCHAFFZIN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 N FRESNO ST
FRESNO CA
93720-2041
US

IV. Provider business mailing address

2176 HIGHGATE RD
WESTLAKE VILLAGE CA
91361-3523
US

V. Phone/Fax

Practice location:
  • Phone: 800-242-0880
  • Fax: 559-492-5635
Mailing address:
  • Phone: 805-657-5567
  • Fax: 805-496-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG33746
License Number StateCA

VIII. Authorized Official

Name: MS. NICHELLE CHRISTINE VASQUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-381-1953