Healthcare Provider Details

I. General information

NPI: 1144215906
Provider Name (Legal Business Name): RENAE WITT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22032 EL PASEO SUITE 140
RANCHO SANTA MARGARITA CA
92688-3947
US

IV. Provider business mailing address

22032 EL PASEO SUITE 140
RANCHO SANTA MARGARITA CA
92688-3947
US

V. Phone/Fax

Practice location:
  • Phone: 949-766-8505
  • Fax:
Mailing address:
  • Phone: 949-766-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: