Provider Demographics
NPI:1043303027
Name:JOHN WITCZAK, DO, PC
Entity Type:Organization
Organization Name:JOHN WITCZAK, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-348-2250
Mailing Address - Street 1:26921 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6501
Mailing Address - Country:US
Mailing Address - Phone:949-348-2250
Mailing Address - Fax:949-348-8904
Practice Address - Street 1:26921 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6501
Practice Address - Country:US
Practice Address - Phone:949-348-2250
Practice Address - Fax:949-348-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4682OtherLICENSE
CAW20A4682BMedicare ID - Type Unspecified
CA20A4682OtherLICENSE