Healthcare Provider Details

I. General information

NPI: 1659802767
Provider Name (Legal Business Name): MITCHELL JON SCHOEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24785 STEWART ST STE 204
LOMA LINDA CA
92350-1721
US

IV. Provider business mailing address

1160 E 27TH ST
SAN BERNARDINO CA
92404-4137
US

V. Phone/Fax

Practice location:
  • Phone: 909-651-5809
  • Fax:
Mailing address:
  • Phone: 763-218-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA163108
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA163108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: