Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A5391 | CA |
NPI | 1235253592 |
---|---|
Provider Name | Michael Schreiber |
First Address | San Pedro, CA 90731-3118 |
Second Address | San Pedro, CA 90731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 17/05/2018 |