Provider Demographics
NPI:1467506568
Name:SCHMIDT, MELODY (PA-C)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:626-795-7556
Mailing Address - Fax:
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14920BMedicare ID - Type UnspecifiedVERDUGO
CAW14920AMedicare ID - Type UnspecifiedARCADIA
CAW14920Medicare ID - Type UnspecifiedPASADENA
CAP04167Medicare UPIN