Healthcare Provider Details

I. General information

NPI: 1316239080
Provider Name (Legal Business Name): MATTHEW SCHNEIDER DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 SAN VICENTE BLVD SUITE 200
LOS ANGELES CA
90049-6511
US

IV. Provider business mailing address

11633 SAN VICENTE BLVD SUITE 200
LOS ANGELES CA
90049-6511
US

V. Phone/Fax

Practice location:
  • Phone: 310-442-1975
  • Fax: 310-442-1977
Mailing address:
  • Phone: 310-442-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4902
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW LOUIS SCHNEIDER
Title or Position: DOCTOR
Credential: DPM
Phone: 310-442-1975