Provider Demographics
NPI:1487711701
Name:SCHNEIDER, MARK DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 BROOKSHIRE AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241
Mailing Address - Country:US
Mailing Address - Phone:562-904-4411
Mailing Address - Fax:562-904-4415
Practice Address - Street 1:11411 BROOKSHIRE AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-904-4411
Practice Address - Fax:562-904-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC64483Medicare UPIN