MEDICARE: SCHUMAN-LILES CLINIC, INC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1861568909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHUMAN-LILES CLINIC, INC

Provider Business Mailing Address
First Line	:	10850 MACARTHUR BLVD STE 300
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-5266
Country	:	US
Telephone Number	:	510-569-9334
Fax Number	:	510-569-9334

Provider Business Practice Location Address
First Line	:	10850 MACARTHUR BLVD STE 300
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-5266
Country	:	US
Telephone Number	:	510-569-9334
Fax Number	:	510-569-9334

Authorized Official
Title or Position	:	CEO
Name	:	MR. LJ JENNINGS
Credential	:
Telephone Number	:	510-569-9334

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/10/2016

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