Healthcare Provider Details

I. General information

NPI: 1568411189
Provider Name (Legal Business Name): MARK CLIFFORD SCHULTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 VALENCIA BLVD STE 115
VALENCIA CA
91355-9509
US

IV. Provider business mailing address

23823 VALENCIA BLVD STE 115
VALENCIA CA
91355-9509
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-5444
  • Fax: 661-255-8447
Mailing address:
  • Phone: 661-255-5444
  • Fax: 661-255-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberG45233
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG45233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: