Healthcare Provider Details

I. General information

NPI: 1255634747
Provider Name (Legal Business Name): EUGENE L SCHOENFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 LINCOLN AVE STE 207
SAN RAFAEL CA
94901-2121
US

IV. Provider business mailing address

1368 LINCOLN AVE STE 207
SAN RAFAEL CA
94901-2121
US

V. Phone/Fax

Practice location:
  • Phone: 415-331-6832
  • Fax: 415-331-9513
Mailing address:
  • Phone: 415-331-6832
  • Fax: 415-331-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC24333
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC24333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: