Healthcare Provider Details

I. General information

NPI: 1467949693
Provider Name (Legal Business Name): BRITTANY CATHERINE PASSIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY SCHNEIDER

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHILDRENS WAY
SAN DIEGO CA
92123-4232
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5819
  • Fax:
Mailing address:
  • Phone: 858-309-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA195814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number13274777-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA195814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: