Provider Demographics
NPI:1205928579
Name:SCHMITZ, THERESA (PA)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18990 COYOTE VALLEY RD STE 10
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8339
Mailing Address - Country:US
Mailing Address - Phone:707-987-8344
Mailing Address - Fax:707-984-8395
Practice Address - Street 1:18990 COYOTE VALLEY RD STE 10
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8339
Practice Address - Country:US
Practice Address - Phone:707-987-8344
Practice Address - Fax:707-987-8395
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical