Provider Demographics
NPI:1376864454
Name:SCHELLENBERG, LARRY (RCP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SCHELLENBERG
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 CHICKASAW CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2841
Mailing Address - Country:US
Mailing Address - Phone:858-483-3507
Mailing Address - Fax:
Practice Address - Street 1:4727 CHICKASAW CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2841
Practice Address - Country:US
Practice Address - Phone:858-483-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000091872279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist