Provider Demographics
NPI:1437142866
Name:SCHUBOT, ERROL D (PHD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:D
Last Name:SCHUBOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5201
Mailing Address - Country:US
Mailing Address - Phone:408-241-0198
Mailing Address - Fax:
Practice Address - Street 1:1745 SARATOGA AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5201
Practice Address - Country:US
Practice Address - Phone:408-241-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY003164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9552014OtherBLUE CROSS
00PL31640Medicare ID - Type Unspecified