=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114937539
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | C. DEAN HARTWIG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 11/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1961 LAS PLUMAS AVE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95133-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-251-9300
-----------------------------------------------------
Fax | 408-251-9400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1961 LAS PLUMAS AVE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95133-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-251-9300
-----------------------------------------------------
Fax | 408-251-9400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C32784
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------