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General NPI Number Information
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NPI Number | 1487460341
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Entity Type | Individual
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Provider Name | XANDER MARIA ROBERTUS VAN WIJK PHD, DABCC, FADLM
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Gender | Male
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 185 BERRY ST STE 290
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-1773
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Country | US
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Telephone | 415-476-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 185 BERRY ST STE 290
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-1773
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | MTC-02003337
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License Number State | CA
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