Provider Demographics
NPI:1790956324
Name:SCHAENMAN, JOANNA MIRIAM (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MIRIAM
Last Name:SCHAENMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MED PLZ
Mailing Address - Street 2:365
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-794-6553
Mailing Address - Fax:310-825-3632
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:# 309
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-319-4371
Practice Address - Fax:310-319-4141
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80357207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790956324Medicaid
CA1790956324OtherCCS PANELED
CA1790956324Medicaid