Provider Demographics
NPI:1467558718
Name:SZMIDT A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:SZMIDT A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOLANTA
Authorized Official - Last Name:SZMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-259-5655
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3083
Mailing Address - Country:US
Mailing Address - Phone:858-259-5655
Mailing Address - Fax:858-259-5638
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:#100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3083
Practice Address - Country:US
Practice Address - Phone:858-259-5655
Practice Address - Fax:858-259-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF70952Medicare UPIN