Provider Demographics
NPI:1679667182
Name:SHULZE, ROMAN A (DO)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:A
Last Name:SHULZE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:1717 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4345
Practice Address - Country:US
Practice Address - Phone:714-635-2642
Practice Address - Fax:714-635-8547
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8047207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A80470Medicare PIN
CACZ322ZMedicare PIN
CACB238861Medicare PIN
CAH78549Medicare UPIN
CACA162111Medicare PIN