Healthcare Provider Details

I. General information

NPI: 1598987828
Provider Name (Legal Business Name): CRISTIAN J WEDEKIND CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

PO BOX 1374
MENLO PARK CA
94026-1374
US

V. Phone/Fax

Practice location:
  • Phone: 650-322-4222
  • Fax: 650-322-4222
Mailing address:
  • Phone: 650-322-4222
  • Fax: 650-322-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number810111-1120
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: