Healthcare Provider Details

I. General information

NPI: 1194789628
Provider Name (Legal Business Name): LUCY MARIE SCHMIDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N SAN MATEO DR STE C
SAN MATEO CA
94401-4523
US

IV. Provider business mailing address

177 BOVET RD FL 6 ATTN: CD BILLING, LLC
SAN MATEO CA
94402-3116
US

V. Phone/Fax

Practice location:
  • Phone: 650-344-4142
  • Fax: 650-344-0619
Mailing address:
  • Phone: 701-255-9279
  • Fax: 701-222-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberC33449
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC33449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: