MEDICARE: CLEO SCHMITT

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	103K00000X	Behavior Analyst	1-14-15962	MA

General Provider Information

NPI Number	:	1528476199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEO SCHMITT

Provider Business Mailing Address
First Line	:	3169 COWLEY WAY APT 119
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6553
Country	:	US
Telephone Number	:	203-947-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	15373 INNOVATION DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3425
Country	:	US
Telephone Number	:	858-699-7579
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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