Healthcare Provider Details

I. General information

NPI: 1912999087
Provider Name (Legal Business Name): DAVID W SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date: 08/14/2018
Reactivation Date: 09/17/2018

III. Provider practice location address

29645 RANCHO CALIFORNIA RD STE 109
TEMECULA CA
92591-5285
US

IV. Provider business mailing address

29645 RANCHO CALIFORNIA RD STE 109
TEMECULA CA
92591-5285
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-3626
  • Fax: 951-694-3627
Mailing address:
  • Phone: 951-694-3626
  • Fax: 951-694-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG205620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG205620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: