1063419273 NPI number — JESSICA LYNN SCHNEIDER M.D.

Table of content: JESSICA LYNN SCHNEIDER M.D. (NPI 1063419273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063419273 NPI number — JESSICA LYNN SCHNEIDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
JESSICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063419273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8631 W 3RD ST
Provider Second Line Business Mailing Address:
SUITE 510E
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-659-9104
Provider Business Mailing Address Fax Number:
310-659-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10309 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
# 300
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-557-3766
Provider Business Practice Location Address Fax Number:
310-282-8567
Provider Enumeration Date:
07/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A67526 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)