Provider Demographics
NPI:1851435374
Name:SCHMIDT, ANNE RYBACK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:RYBACK
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2045
Mailing Address - Country:US
Mailing Address - Phone:310-828-6235
Mailing Address - Fax:310-828-0158
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2045
Practice Address - Country:US
Practice Address - Phone:310-828-6235
Practice Address - Fax:310-828-0158
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043508261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA043508OtherSTATE LICENSE
CABR0940583OtherDEA
CABR0940583OtherDEA