Provider Demographics
NPI:1124182324
Name:SCHULTZ, ARMIDA TREZZA (CDE)
Entity Type:Individual
Prefix:
First Name:ARMIDA
Middle Name:TREZZA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13847 E 14TH
Mailing Address - Street 2:#216
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578
Mailing Address - Country:US
Mailing Address - Phone:510-351-1193
Mailing Address - Fax:510-351-6456
Practice Address - Street 1:13847 E 14TH
Practice Address - Street 2:#216
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-351-1193
Practice Address - Fax:510-351-6456
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACDE 0952-0441163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09520441OtherNATL CERT BOARD OF DIABET
CAZZZ15328ZOtherPTAN
CAZZZ29277ZOtherPTAN