Provider Demographics
NPI:1477665248
Name:SCHWARTZ, CAROL ROSE (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ROSE
Last Name:SCHWARTZ
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 1:2509 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1828
Mailing Address - Country:US
Mailing Address - Phone:310-392-8636
Mailing Address - Fax:310-829-4632
Practice Address - Street 1:2509 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1828
Practice Address - Country:US
Practice Address - Phone:310-392-8636
Practice Address - Fax:310-829-4632
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG69586EMedicare ID - Type Unspecified
CAWG69586DMedicare ID - Type Unspecified
CAWG69586CMedicare ID - Type Unspecified
CAWG69586BMedicare ID - Type Unspecified