Healthcare Provider Details

I. General information

NPI: 1205928579
Provider Name (Legal Business Name): THERESA SCHMITZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18990 COYOTE VALLEY RD STE 10
HIDDEN VALLEY LAKE CA
95467-8339
US

IV. Provider business mailing address

18990 COYOTE VALLEY RD STE 10
HIDDEN VALLEY LAKE CA
95467-8339
US

V. Phone/Fax

Practice location:
  • Phone: 707-987-8344
  • Fax: 707-987-8395
Mailing address:
  • Phone: 707-987-8344
  • Fax: 707-984-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: