Healthcare Provider Details

I. General information

NPI: 1477563302
Provider Name (Legal Business Name): WADE D SCHWENDEMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST STE 300
SAN DIEGO CA
92123-2778
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE #210
SAN DIEGO CA
92123-4802
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-6880
  • Fax:
Mailing address:
  • Phone: 858-309-6303
  • Fax: 858-309-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA109228
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA109228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: