1649363565 NPI number — MRS. SHERRI JANE SCHWEER NP16601

Table of content: MRS. SHERRI JANE SCHWEER NP16601 (NPI 1649363565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649363565 NPI number — MRS. SHERRI JANE SCHWEER NP16601

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWEER
Provider First Name:
SHERRI
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP16601
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHILPOT
Provider Other First Name:
SHERRY
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649363565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4290 POLK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92105-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-563-0507
Provider Business Mailing Address Fax Number:
619-563-0015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4305 UNIVERSITY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-0507
Provider Business Practice Location Address Fax Number:
619-563-0015
Provider Enumeration Date:
10/02/2006

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: 363LF0000X , with the licence number:  NP16601 , 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)





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