Provider Demographics
NPI:1285039206
Name:CLAYTON L. SCHILTZ, D.O., INC.
Entity Type:Organization
Organization Name:CLAYTON L. SCHILTZ, D.O., INC.
Other - Org Name:COASTAL DERMATOLOGY AND AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-886-3676
Mailing Address - Street 1:337 QUEBRADA DEL MAR RD
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4315
Mailing Address - Country:US
Mailing Address - Phone:619-886-3676
Mailing Address - Fax:
Practice Address - Street 1:7888 WREN AVE STE A110
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4963
Practice Address - Country:US
Practice Address - Phone:408-713-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13538207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty