Provider Demographics
NPI:1205811023
Name:SCHOFIELD, JOHN KELLY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLY
Last Name:SCHOFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SANTA MONICA BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2307
Mailing Address - Country:US
Mailing Address - Phone:310-205-5400
Mailing Address - Fax:310-205-5562
Practice Address - Street 1:2222 SANTA MONICA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2307
Practice Address - Country:US
Practice Address - Phone:310-205-5400
Practice Address - Fax:310-205-5562
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX83360 .Medicaid
CAH88195Medicare UPIN
CAW19150Medicare ID - Type UnspecifiedMEDICARE PROVIDER #