Basic Information
Provider Information
NPI: 1104161728
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHULTZ
FirstName: RHONDA
MiddleName: MICHELLE
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1445 E FLORIDA ST
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908023507
CountryCode: US
TelephoneNumber: 5622851330
FaxNumber: 5622851330
Practice Location
Address1: 100 W BROADWAY
Address2: SUITE 5010
City: LONG BEACH
State: CA
PostalCode: 908024431
CountryCode: US
TelephoneNumber: 5622851330
FaxNumber: 5622851330
Other Information
ProviderEnumerationDate: 12/07/2012
LastUpdateDate: 12/07/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225400000X CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 

No ID Information.


Home