MEDICARE: MARK S SHULMAN MD

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	207L00000X	Anesthesiology Physician	G36884	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275520371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S SHULMAN MD

Provider Business Mailing Address
First Line	:	1414 MANERA VENTOSA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-3663
Country	:	US
Telephone Number	:	413-813-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 MANERA VENTOSA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-3663
Country	:	US
Telephone Number	:	413-813-9539
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	12/20/2023

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