Provider Demographics
NPI:1235174665
Name:SCHULMAN, JENNIE BRAVO (PAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:BRAVO
Last Name:SCHULMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:909 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402
Mailing Address - Country:US
Mailing Address - Phone:303-882-3930
Mailing Address - Fax:
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:TRI CITY HEALTH CENTER
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-770-8133
Practice Address - Fax:510-770-8140
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant