Provider Demographics
NPI:1477019396
Name:SCHUTZ, SALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:SCHUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:RABKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:928 N. SAN VICENTE BLVD
Mailing Address - Street 2:#204
Mailing Address - City:W. HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3850
Mailing Address - Country:US
Mailing Address - Phone:310-948-5152
Mailing Address - Fax:
Practice Address - Street 1:928 N. SAN VICENTE BLVD
Practice Address - Street 2:#204
Practice Address - City:W. HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3850
Practice Address - Country:US
Practice Address - Phone:310-948-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology