Provider Demographics
NPI:1700958667
Name:SCHOENWETTER, PHILLIP EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:EDWARD
Last Name:SCHOENWETTER
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 1:30511 EAST PALOS VERDES DR.
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6593
Mailing Address - Country:US
Mailing Address - Phone:310-732-1999
Mailing Address - Fax:310-427-7630
Practice Address - Street 1:787 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3601
Practice Address - Country:US
Practice Address - Phone:310-832-0258
Practice Address - Fax:310-833-9825
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA030285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84073Medicare UPIN