Provider Demographics
NPI:1457455818
Name:SCHMITT, CATHLEEN E (MD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:E
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-2156
Mailing Address - Country:US
Mailing Address - Phone:415-269-0584
Mailing Address - Fax:
Practice Address - Street 1:1615 HILL RD
Practice Address - Street 2:#14
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947
Practice Address - Country:US
Practice Address - Phone:415-897-2776
Practice Address - Fax:415-897-0097
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG05812J207Q00000X
CAG58125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G581250Medicaid
CA00G581250Medicare ID - Type Unspecified
CA00G581250Medicaid