Healthcare Provider Details

I. General information

NPI: 1902994197
Provider Name (Legal Business Name): RICHARD WITTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 ATLANTIC AVE STE 149
LONG BEACH CA
90806-7411
US

IV. Provider business mailing address

2865 ATLANTIC AVE STE 149
LONG BEACH CA
90806-7411
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-1879
  • Fax: 562-595-0135
Mailing address:
  • Phone: 562-595-1879
  • Fax: 562-595-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG16378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: