Healthcare Provider Details

I. General information

NPI: 1659831212
Provider Name (Legal Business Name): COURTNEY LINDE DECAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY SCHUELKE MD, MPH

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 15TH ST STE 102
SANTA MONICA CA
90404-1810
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7921
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA179118
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA179118
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number89997642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: