Basic Information
| Provider Information | |||||||||
| NPI: | 1770798282 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | R. ANDREW SCHULTZ-ROSS, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1918 | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945350918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089362899 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4315 CEREDA LN | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945341561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089362899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 04/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTZ-ROSS | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8089362899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | MD7875 | HI | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.