Provider Demographics
NPI:1710966155
Name:SCHNEPPER, FRED WALTER (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:WALTER
Last Name:SCHNEPPER
Suffix:
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 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE #8
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-482-2400
Mailing Address - Fax:619-482-2411
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:SUITE #8
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-482-2400
Practice Address - Fax:619-482-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7025174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G70250Medicaid
CAA57695Medicare UPIN
CA000G70250Medicaid