Provider Demographics
NPI:1417461187
Name:SCHNEIDER, JUSTIN PETER (SFIDC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PETER
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 TEXAS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2742
Mailing Address - Country:US
Mailing Address - Phone:808-227-1396
Mailing Address - Fax:
Practice Address - Street 1:3936 TEXAS ST APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2742
Practice Address - Country:US
Practice Address - Phone:808-227-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman