=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548362577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA E. WITTENBERG M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 09/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5855 E. 2ND STREET SUITE 307
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-266-7284
-----------------------------------------------------
Fax | 562-433-4342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5855E NAPLES PLZ 307
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90803-5091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-434-0650
-----------------------------------------------------
Fax | 562-434-0641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A90355
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------