Healthcare Provider Details

I. General information

NPI: 1306241831
Provider Name (Legal Business Name): HEIDI WITTENBERG, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRANCISCO ST SUITE 300
SAN FRANCISCO CA
94133-2122
US

IV. Provider business mailing address

2269 CHESTNUT ST 130
SAN FRANCISCO CA
94123-2600
US

V. Phone/Fax

Practice location:
  • Phone: 415-395-9895
  • Fax: 415-395-9897
Mailing address:
  • Phone: 415-395-9895
  • Fax: 415-395-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HEIDI WITTENBERG
Title or Position: OWNER
Credential: MD
Phone: 415-308-0691