1245272004 NPI number — DR. ANDREW IRA SCHWARTZ D.O.

Table of content: DR. ANDREW IRA SCHWARTZ D.O. (NPI 1245272004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245272004 NPI number — DR. ANDREW IRA SCHWARTZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
ANDREW
Provider Middle Name:
IRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1245272004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 DISTEL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94022-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-585-8347
Provider Business Mailing Address Fax Number:
707-573-5424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 SNYDER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROHNERT PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94928-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-585-8347
Provider Business Practice Location Address Fax Number:
707-573-5424
Provider Enumeration Date:
06/13/2006

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: 207Q00000X , with the licence number:  20A10017 , 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: 5315025405 . This is a "CONTROLLED SUBSTANCE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20A 10017 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5101016693 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OS 10051 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FHC71031F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1508E . This is a "PTAN, BV362YZ AND BV362Y," identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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