Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G21861 | CA |
N | 207VG0400X | Gynecologist | G21861 | CA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G21861 | CA |
N | 207VX0000X | Obstetrician | G21861 | CA |
NPI | 1245300268 |
---|---|
Provider Name | Bert B Schoenkerman |
First Address | Thousand Oaks, CA 91360-8033 |
Second Address | Thousand Oaks, CA 91360-8033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G218610 | (05) | CA |
A41406 | (02) | CA |