Healthcare Provider Details

I. General information

NPI: 1184686255
Provider Name (Legal Business Name): DEBRA DENISE WITTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 THORNTON AVE SUITE A
NEWARK CA
94560-3700
US

IV. Provider business mailing address

6170 THORNTON AVE SUITE A
NEWARK CA
94560-3700
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-3121
  • Fax: 510-797-2848
Mailing address:
  • Phone: 510-797-3121
  • Fax: 510-797-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG56606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: