Provider Demographics
NPI:1164555660
Name:SCHUMAN-LILES CLINIC, INC
Entity Type:Organization
Organization Name:SCHUMAN-LILES CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LJ
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-569-9334
Mailing Address - Street 1:10850 MACARTHUR BLVD
Mailing Address - Street 2:300
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5266
Mailing Address - Country:US
Mailing Address - Phone:510-569-9334
Mailing Address - Fax:510-569-9309
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:G700
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-505-9141
Practice Address - Fax:510-505-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70207ZMedicare UPIN