Healthcare Provider Details

I. General information

NPI: 1316527435
Provider Name (Legal Business Name): NICHOLAS SCHMIDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 900
LA JOLLA CA
92037-1220
US

IV. Provider business mailing address

9850 GENESEE AVE STE 900
LA JOLLA CA
92037-1220
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-1279
  • Fax:
Mailing address:
  • Phone: 731-695-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number193456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: