Basic Information
| Provider Information | |||||||||
| NPI: | 1235174665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULMAN | ||||||||
| FirstName: | JENNIE | ||||||||
| MiddleName: | BRAVO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BRAVO | ||||||||
| OtherFirstName: | JENNIE | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 909 FLEETWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038823930 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 39500 LIBERTY ST | ||||||||
| Address2: | TRI CITY HEALTH CENTER | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107708133 | ||||||||
| FaxNumber: | 5107708140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 06/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA18175 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.