1942246582 NPI number — GARY J. SCHUMMER, APC

Table of content: (NPI 1942246582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942246582 NPI number — GARY J. SCHUMMER, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY J. SCHUMMER, APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADD TREATMENT CENTER
Provider Other Organization Name Type Code:
3
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:
1942246582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27725 SANTA MARGARITA PKWY
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-6704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-272-3870
Provider Business Mailing Address Fax Number:
949-951-2802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27725 SANTA MARGARITA PKWY
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-272-3870
Provider Business Practice Location Address Fax Number:
949-951-2802
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DU BRUYNE
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
949-272-3870

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 12832 , 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)

  • Identifier: PSY 12832 . This is a "CLINICAL PSYCH LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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