Healthcare Provider Details

I. General information

NPI: 1720315971
Provider Name (Legal Business Name): BETHANN SCHABER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 OVERLAND AVE SAN DIEGO CO MEDICAL EXAMINERS, STE. 1411
SAN DIEGO CA
92123-1200
US

IV. Provider business mailing address

5555 OVERLAND AVE SAN DIEGO CO MEDICAL EXAMINERS, STE. 1411
SAN DIEGO CA
92123-1200
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-2904
  • Fax:
Mailing address:
  • Phone: 858-694-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA063181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: