Provider Demographics
NPI:1912999087
Name:SCHWARTZ, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:SCHWARTZ
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 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE 109
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5285
Mailing Address - Country:US
Mailing Address - Phone:951-694-3626
Mailing Address - Fax:951-694-3627
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE 109
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5285
Practice Address - Country:US
Practice Address - Phone:951-694-3626
Practice Address - Fax:951-694-3627
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-09-27
Deactivation Date:2018-08-14
Deactivation Code:
Reactivation Date:2018-09-17
Provider Licenses
StateLicense IDTaxonomies
CAG205620208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G205620Medicare ID - Type Unspecified
CAA40955Medicare UPIN