Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A163108 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A163108 | CA |
NPI | 1659802767 |
---|---|
Provider Name | Dr. Mitchell Jon Schoen |
First Address | San Bernardino, CA 92404-4137 |
Second Address | San Bernardino, CA 92410-3320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 02/12/2020 |