Healthcare Provider Details

I. General information

NPI: 1215922935
Provider Name (Legal Business Name): JOHN S. SCHOENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 EATON AVE STE 5
SAN CARLOS CA
94070-5233
US

IV. Provider business mailing address

1213 EATON AVE STE 5
SAN CARLOS CA
94070-5233
US

V. Phone/Fax

Practice location:
  • Phone: 650-591-1183
  • Fax: 650-508-1204
Mailing address:
  • Phone: 650-591-1183
  • Fax: 650-508-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG508210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG50821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: