Provider Demographics
NPI:1033634936
Name:SCHNEIDER-AGUILERA, DAVID (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SCHNEIDER-AGUILERA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6140 W CURTISIAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5600
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:6140 W CURTISIAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8907
Practice Address - Country:US
Practice Address - Phone:208-327-5600
Practice Address - Fax:208-327-5602
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IDPA-1522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1033634936Medicaid
ID100001877329OtherREGENCE BLUESHIELD OF IDAHO
IDPADJ2OtherBLUE CROSS OF IDAHO