Healthcare Provider Details

I. General information

NPI: 1306136635
Provider Name (Legal Business Name): MRS. RENEE ANNETTE WULFF-WESTERHEIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29122 RANCHO VIEJO RD #204
SAN JUAN CAPISTRANO CA
92675-1018
US

IV. Provider business mailing address

33962 CALLE DE BONANZA
SAN JUAN CAPISTRANO CA
92675-5025
US

V. Phone/Fax

Practice location:
  • Phone: 949-547-8226
  • Fax: 858-444-8827
Mailing address:
  • Phone: 949-547-8226
  • Fax: 858-444-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: