Healthcare Provider Details

I. General information

NPI: 1306014402
Provider Name (Legal Business Name): PERRI L WITTGROVE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD #302
SAN DIEGO CA
92120-5270
US

IV. Provider business mailing address

6719 ALVARADO RD #302
SAN DIEGO CA
92120-5270
US

V. Phone/Fax

Practice location:
  • Phone: 619-326-0700
  • Fax: 619-326-0703
Mailing address:
  • Phone: 619-326-0700
  • Fax: 619-326-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG56550
License Number StateCA

VIII. Authorized Official

Name: PERRI L WITTGROVE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 619-326-0700