Provider Demographics
NPI:1043489537
Name:SCHLOMO SCHMUEL, DPM INC
Entity type:Organization
Organization Name:SCHLOMO SCHMUEL, DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-483-4246
Mailing Address - Street 1:12125 VANOWEN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605
Mailing Address - Country:US
Mailing Address - Phone:213-483-4246
Mailing Address - Fax:213-483-7257
Practice Address - Street 1:2711 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2101
Practice Address - Country:US
Practice Address - Phone:213-483-4246
Practice Address - Fax:213-483-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3848213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1057540001Medicare NSC
CAU33829Medicare UPIN
E3848Medicare PIN