Provider Demographics
NPI:1134494362
Name:WETTSTEIN, PAUL RAYMOND
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RAYMOND
Last Name:WETTSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:
Other - Last Name:WETTSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 S. GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4618
Mailing Address - Country:US
Mailing Address - Phone:209-533-6245
Mailing Address - Fax:
Practice Address - Street 1:105 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4618
Practice Address - Country:US
Practice Address - Phone:209-533-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator