Provider Demographics
NPI:1801832522
Name:SCHNIEROW, BRADLEY J (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:SCHNIEROW
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 1:13537 MANGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3538
Mailing Address - Country:US
Mailing Address - Phone:858-623-3266
Mailing Address - Fax:858-630-2426
Practice Address - Street 1:9834 GENESEE AVENUE
Practice Address - Street 2:SUITE 112
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-623-3266
Practice Address - Fax:858-630-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG776392084N0400X
CAA677802084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18651Medicare PIN
CAG77639Medicare UPIN
CAWA67790AMedicare ID - Type Unspecified