Provider Demographics
NPI:1467778498
Name:FREDERICK W. SCHWERTLEY - MEDICAL CORP.
Entity Type:Organization
Organization Name:FREDERICK W. SCHWERTLEY - MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHWERTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-996-1511
Mailing Address - Street 1:10373 TORRE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3260
Mailing Address - Country:US
Mailing Address - Phone:408-996-1511
Mailing Address - Fax:408-996-7349
Practice Address - Street 1:10373 TORRE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3260
Practice Address - Country:US
Practice Address - Phone:408-996-1511
Practice Address - Fax:408-996-7349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24063305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC24063OtherMEDICAL LICENSE