Healthcare Provider Details

I. General information

NPI: 1578861324
Provider Name (Legal Business Name): EDWARD WILLIAM SCHEINERT IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 RENDOVA RD SUITE 156 NSWG-1 LOGSUPPU
SAN DIEGO CA
92155-5401
US

IV. Provider business mailing address

2424 RENDOVA RD SUITE 156 NSWG-1 LOGSUPPU
SAN DIEGO CA
92155-5401
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-5612
  • Fax:
Mailing address:
  • Phone: 619-437-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: