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NPI Code Detail

MEDICARE: PHYLLIS ELENOR SCHOENWALD PA

MEDICARE: PHYLLIS ELENOR SCHOENWALD PA
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
1363A00000XPhysician AssistantPA51167CA

General Provider Information

NPI Number : 1447319439
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS ELENOR SCHOENWALD PA
Provider Business Mailing Address
First Line : 2185 PACHECO ST
Second Line :
City : CONCORD
State : CA
Zip : 94520-2309
Country : US
Telephone Number : 925-676-0505
Fax Number :
Provider Business Practice Location Address
First Line : 2185 PACHECO ST
Second Line :
City : CONCORD
State : CA
Zip : 94520-2309
Country : US
Telephone Number : 925-676-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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Directions to “ PHYLLIS ELENOR SCHOENWALD PA” Practice Location

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