Healthcare Provider Details

I. General information

NPI: 1992382394
Provider Name (Legal Business Name): RENATA YVONNE WETTERMANN CAPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENATA YVONNE WETTERMANN

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

1545 DIVISADERO ST STE 322
SAN FRANCISCO CA
94143-3400
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax:
Mailing address:
  • Phone: 415-514-8686
  • Fax: 415-514-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2025-0283
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2025-0283
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: