Provider Demographics
NPI:1093732935
Name:WARDZINSKA, JANE HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:HELEN
Last Name:WARDZINSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-895-8700
Mailing Address - Fax:510-895-8725
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-895-8700
Practice Address - Fax:510-895-8725
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A384900Medicaid
CA00A384900Medicare ID - Type Unspecified
CA00A384900Medicaid