Healthcare Provider Details

I. General information

NPI: 1609838465
Provider Name (Legal Business Name): LILA LAYNE SCHMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVENUE # 610
SAN DIEGO CA
92103-2121
US

IV. Provider business mailing address

4060 4TH AVENUE # 610
SAN DIEGO CA
92103-2121
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-4050
  • Fax:
Mailing address:
  • Phone: 619-295-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG066982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: