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General NPI Number Information
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NPI Number | 1437468501
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Entity Type | Organization
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Legal Business Name | DREW HITTENBERGER
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 181 LYNCH CREEK WAY SUITE 101
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City | PETALUMA
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State | CA
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Zip | 94954-2372
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Country | US
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Telephone | 707-765-1122
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Fax | 707-765-4571
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Provider Business Mailing Address
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Address Line | 181 LYNCH CREEK WAY SUITE 101
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City | PETALUMA
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State | CA
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Zip | 94954-2372
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Country | US
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Telephone | 707-765-1122
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Fax | 707-765-4571
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Authorized Official
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Title or Position | OWNER
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Name | MR. DREW ARNOLD HITTENBERGER
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Credential | CP .BOCO
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Telephone | 707-765-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CP1093
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License Number State | CA
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