MEDICARE: CONSUELO SCHRODER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	57826	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57826	OTHER	CA	CAMTC

General Provider Information

NPI Number	:	1164360525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSUELO SCHRODER

Provider Business Mailing Address
First Line	:	440 W OFARRELL ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-2104
Country	:	US
Telephone Number	:	310-986-9332
Fax Number	:	310-986-9332

Provider Business Practice Location Address
First Line	:	148 MAIN ST STE G
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6386
Country	:	US
Telephone Number	:	310-986-9332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ CONSUELO SCHRODER ” Practice Location

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