Healthcare Provider Details

I. General information

NPI: 1396155446
Provider Name (Legal Business Name): SHARON ORBACH WIETSTOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH STREET FLOOR 4 UCSF PEDIATRICS
SAN FRANCISCO CA
94158-2549
US

IV. Provider business mailing address

550 16TH STREET FLOOR 4 UCSF PEDIATRICS
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5001
  • Fax:
Mailing address:
  • Phone: 415-476-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA141854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: