Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT20726 | CA |
Y | 213ES0000X | Sports Medicine | PT20726 | CA |
N | 2081S0010X | Sports Medicine | PT20726 | CO |
N | 213ES0000X | Sports Medicine | PT20726 | CO |
NPI | 1326506478 |
---|---|
Provider Name | Stacia Robinson Schroeder |
First Address | Walnut Creek, CA 94597-2168 |
Second Address | Brentwood, CA 94513-5194 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2019 |
Last Update Date | 30/07/2019 |