MEDICARE: DR. GEORGIA GRACE SCHWARTZ 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	2080A0000X	Pediatric Adolescent Medicine Physician	G-22007	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G-22007	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1346367844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGIA GRACE SCHWARTZ MD

Provider Business Mailing Address
First Line	:	1801 E COTATI AVE
Second Line	:	STUDENT HEALTH CENTER
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-3613
Country	:	US
Telephone Number	:	707-664-2921
Fax Number	:	707-664-2925

Provider Business Practice Location Address
First Line	:	1801 E COTATI AVE
Second Line	:	STUDENT HEALTH CENTER
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-3613
Country	:	US
Telephone Number	:	707-664-2921
Fax Number	:	707-664-2925

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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