Provider Demographics
NPI:1629403647
Name:SCHWAB, KIRSTEN M (PA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 CALLE DE LA PLATA STE 120
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3632
Mailing Address - Country:US
Mailing Address - Phone:949-588-7246
Mailing Address - Fax:866-829-7143
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3632
Practice Address - Country:US
Practice Address - Phone:949-588-7246
Practice Address - Fax:866-829-7143
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001564A363A00000X
CA53423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN177280011Medicare PIN