Healthcare Provider Details

I. General information

NPI: 1346291770
Provider Name (Legal Business Name): MICHAEL ROBERT SCHROEDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 ORANGEWOOD DR
RIVERSIDE CA
92504-1034
US

IV. Provider business mailing address

7410 ORANGEWOOD DR
RIVERSIDE CA
92504-1034
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-0550
  • Fax: 951-509-0500
Mailing address:
  • Phone: 951-509-0550
  • Fax: 951-509-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number45156
License Number StateCA

VIII. Authorized Official

Name: MRS. JENNIFER NICHOLLE GOMEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-509-0550