Provider Demographics
NPI:1083766331
Name:DREW HITTENBERGER AND ASSOCIATES
Entity Type:Organization
Organization Name:DREW HITTENBERGER AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:HITTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:707-765-1122
Mailing Address - Street 1:181 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-765-1122
Mailing Address - Fax:707-765-4571
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4819
Practice Address - Country:US
Practice Address - Phone:707-765-1122
Practice Address - Fax:707-765-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000120Medicaid
CA4129830001Medicare ID - Type UnspecifiedMEDICARE