Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G64889 | CA |
NPI | 1003157934 |
---|---|
Provider Name | Joann Schneider |
First Address | Riverside, CA 92506-2857 |
Second Address | Riverside, CA 92506-2857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2013 |
Last Update Date | 01/03/2013 |