Provider Demographics
NPI:1629486006
Name:SCHAUT, ELIZABETH F (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:SCHAUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 LANDIS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2650
Mailing Address - Country:US
Mailing Address - Phone:619-426-9600
Mailing Address - Fax:
Practice Address - Street 1:256 LANDIS AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2650
Practice Address - Country:US
Practice Address - Phone:619-426-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3355-23363A00000X
CAPA54293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400155301Medicare PIN