Healthcare Provider Details

I. General information

NPI: 1720262330
Provider Name (Legal Business Name): SLAWOMIR WOJTOWICZ-PRAGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DNA WAY GENENTECH, MAILSTOP 444A
SOUTH SAN FRANCISCO CA
94080-4918
US

IV. Provider business mailing address

1 DNA WAY GENENTECH, MAILSTOP 444A
SOUTH SAN FRANCISCO CA
94080-4918
US

V. Phone/Fax

Practice location:
  • Phone: 650-467-9092
  • Fax:
Mailing address:
  • Phone: 650-467-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA06515300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC 53872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: