Healthcare Provider Details

I. General information

NPI: 1699272161
Provider Name (Legal Business Name): CHRISTINA LYNNEA SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 AVIATION WAY STE 200
WATSONVILLE CA
95076-2059
US

IV. Provider business mailing address

195 AVIATION WAY
WATSONVILLE CA
95076-2053
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone: 831-728-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95136393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: