Provider Demographics
NPI:1639102528
Name:SCHNEIDER, JOSEPH ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SCHNEIDER
Suffix:JR
Gender:M
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:PO BOX 2370
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516
Mailing Address - Country:US
Mailing Address - Phone:951-683-1174
Mailing Address - Fax:951-682-1253
Practice Address - Street 1:6848 MAGNOLIA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-683-1174
Practice Address - Fax:951-682-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-05-01
Deactivation Date:2017-04-19
Deactivation Code:
Reactivation Date:2017-04-26
Provider Licenses
StateLicense IDTaxonomies
CAG65121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1009738OtherCLIA NUMBER
CA00G651210Medicare PIN
F06869Medicare UPIN