Provider Demographics
NPI:1679699664
Name:SCHROEDER, WAYNE BROOKS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BROOKS
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1838
Mailing Address - Country:US
Mailing Address - Phone:949-552-0275
Mailing Address - Fax:
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0315
Practice Address - Country:US
Practice Address - Phone:949-552-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR31366Medicare UPIN
CACP8347Medicare ID - Type Unspecified