Provider Demographics
NPI:1598954190
Name:SCHWEITZER, TIMOTHY WARREN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WARREN
Last Name:SCHWEITZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 WOODSIDE RD # 211
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2446
Mailing Address - Country:US
Mailing Address - Phone:650-851-8577
Mailing Address - Fax:
Practice Address - Street 1:80 WHY WORRY LN
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-3654
Practice Address - Country:US
Practice Address - Phone:650-851-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41885207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3650518Medicaid
CAA89741Medicare UPIN
CA00G418850Medicare PIN