Basic Information
Provider Information | |||||||||
NPI: | 1427125533 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHAAF | ||||||||
FirstName: | VIRGINIA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SCHAAF | ||||||||
OtherFirstName: | MYLO | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 300 PROFESSIONAL CENTER DR | ||||||||
Address2: | SUITE 311 | ||||||||
City: | NOVATO | ||||||||
State: | CA | ||||||||
PostalCode: | 949474334 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4154481555 | ||||||||
FaxNumber: | 4158928732 | ||||||||
Practice Location | |||||||||
Address1: | 250 BON AIR RD | ||||||||
Address2: |   | ||||||||
City: | GREENBRAE | ||||||||
State: | CA | ||||||||
PostalCode: | 949041702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4154481500 | ||||||||
FaxNumber: | 4154614229 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/30/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | G54726 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.