Basic Information
| Provider Information | |||||||||
| NPI: | 1588867550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALTER SCHREIBER M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9808 VENICE BLVD STE 605 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902326819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188179832 | ||||||||
| FaxNumber: | 8188179835 | ||||||||
| Practice Location | |||||||||
| Address1: | 9808 VENICE BLVD STE 605 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902326819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188179832 | ||||||||
| FaxNumber: | 8188179835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHREIBER | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8188179832 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A21570 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00A215700 | 05 | CA | MEDICAID |