Provider Demographics
NPI:1003125808
Name:GARY SCHNEIDER D O INC
Entity Type:Organization
Organization Name:GARY SCHNEIDER D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-905-9586
Mailing Address - Street 1:4835 VAN NUYS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2134
Mailing Address - Country:US
Mailing Address - Phone:818-905-9586
Mailing Address - Fax:818-905-0130
Practice Address - Street 1:4835 VAN NUYS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2134
Practice Address - Country:US
Practice Address - Phone:818-905-9586
Practice Address - Fax:818-905-0130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY SCHNEIDER D O INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX41980Medicaid
CAE89324Medicare UPIN