MEDICARE: ANDREW N SCHWARTZ PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY4989	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY4987	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1942323530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW N SCHWARTZ PHD

Provider Business Mailing Address
First Line	:	23120 ALICIA PKWY
Second Line	:	SUITE 241
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-1210
Country	:	US
Telephone Number	:	949-588-5984
Fax Number	:	949-588-6355

Provider Business Practice Location Address
First Line	:	23120 ALICIA PKWY
Second Line	:	SUITE 241
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-1210
Country	:	US
Telephone Number	:	949-588-5984
Fax Number	:	949-588-6355

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	12/10/2007

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