Healthcare Provider Details

I. General information

NPI: 1316520869
Provider Name (Legal Business Name): JACKLYN SCHNEEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 SCHLEE CANYON RD
JAMUL CA
91935-3102
US

IV. Provider business mailing address

3060 SCHLEE CANYON RD
JAMUL CA
91935-3102
US

V. Phone/Fax

Practice location:
  • Phone: 619-609-3474
  • Fax:
Mailing address:
  • Phone: 619-609-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: