Healthcare Provider Details

I. General information

NPI: 1376549022
Provider Name (Legal Business Name): MARY THERESA SCHUH-CLARK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY T SCHUH DPM

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WESTWOOD BLVD STE 220
LOS ANGELES CA
90025-4674
US

IV. Provider business mailing address

1990 WESTWOOD BLVD STE 220
LOS ANGELES CA
90025-4674
US

V. Phone/Fax

Practice location:
  • Phone: 310-475-5377
  • Fax: 310-446-1825
Mailing address:
  • Phone: 310-475-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5996
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE5996
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: