Provider Demographics
NPI:1598168312
Name:SCHMIDT, JOHANNA (MPH, MGC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MPH, MGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11870 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 106429
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2276
Mailing Address - Country:US
Mailing Address - Phone:917-405-5143
Mailing Address - Fax:
Practice Address - Street 1:11870 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 106429
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2276
Practice Address - Country:US
Practice Address - Phone:917-405-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000495170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS