Provider Demographics
NPI:1871528703
Name:SCHULTZ, CHARLES MALCOLM (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MALCOLM
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 221750
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91322-1750
Mailing Address - Country:US
Mailing Address - Phone:661-284-6862
Mailing Address - Fax:661-284-6862
Practice Address - Street 1:23845 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2001
Practice Address - Country:US
Practice Address - Phone:661-253-8112
Practice Address - Fax:661-253-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG69157207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G691570Medicaid
CA00G691570Medicaid
CAWG69157BMedicare PIN