Provider Demographics
NPI:1134136641
Name:SCHOFIELD, JENNIFER LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:SCHOFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13690 E 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-297-0550
Mailing Address - Fax:510-297-0558
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-297-0550
Practice Address - Fax:510-297-0558
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA184980OtherMEDICARE PROVIDER TRANSACTION ACESS NUMBER