Healthcare Provider Details

I. General information

NPI: 1366931651
Provider Name (Legal Business Name): KEVIN MCCABE SCHULTZ DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 07/28/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28602 BAXTER RD
MURRIETA CA
92563
US

IV. Provider business mailing address

45670 SEAGULL WAY
TEMECULA CA
92592-6883
US

V. Phone/Fax

Practice location:
  • Phone: 254-458-4244
  • Fax:
Mailing address:
  • Phone: 254-458-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number836991
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: