Healthcare Provider Details

I. General information

NPI: 1972806255
Provider Name (Legal Business Name): ELYSE SCHOENWALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 ELM AVE SUITE 301
LONG BEACH CA
90806-1651
US

IV. Provider business mailing address

2650 ELM AVE SUITE 301
LONG BEACH CA
90806-1651
US

V. Phone/Fax

Practice location:
  • Phone: 562-728-5034
  • Fax: 562-728-5051
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: