Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY22013 | CA |
NPI | 1104984129 |
---|---|
Provider Name | Dr. Dwayne Schanz |
First Address | San Francisco, CA 94114 |
Second Address | San Francisco, CA 94114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 18/06/2009 |