Provider Demographics
NPI:1982762449
Name:MARTY SCHNEIDER
Entity type:Organization
Organization Name:MARTY SCHNEIDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:925-754-6262
Mailing Address - Street 1:4041 LONE TREE WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6200
Mailing Address - Country:US
Mailing Address - Phone:925-754-6262
Mailing Address - Fax:925-754-2198
Practice Address - Street 1:4041 LONE TREE WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6200
Practice Address - Country:US
Practice Address - Phone:925-754-6262
Practice Address - Fax:925-754-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT117510Medicare ID - Type Unspecified