Provider Demographics
NPI:1073792982
Name:SANDY WITZLING,M.D.,INC.
Entity Type:Organization
Organization Name:SANDY WITZLING,M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WITZLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-1355
Mailing Address - Street 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:SUITE #345
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1516
Mailing Address - Country:US
Mailing Address - Phone:562-426-1355
Mailing Address - Fax:562-490-9711
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:SUITE #345
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-426-1355
Practice Address - Fax:562-490-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84069Medicare UPIN