Provider Demographics
NPI:1730365701
Name:SCHONFELD, JERRY ELLEN (NP)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ELLEN
Last Name:SCHONFELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:PSF GASTROENTEROLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-289-4099
Mailing Address - Fax:714-516-4299
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:PSF GASTROENTEROLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-289-4099
Practice Address - Fax:714-516-4299
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA369891OtherR.N. LIC#
CA7867OtherN.P. LIC. #