Provider Demographics
NPI:1295000453
Name:NOTZON, MANDA JULIEANNE (MD)
Entity Type:Individual
Prefix:
First Name:MANDA
Middle Name:JULIEANNE
Last Name:NOTZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PINOLE VALLEY RD
Mailing Address - Street 2:WOMEN'S HEALTH
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1384
Mailing Address - Country:US
Mailing Address - Phone:510-243-4412
Mailing Address - Fax:
Practice Address - Street 1:1301 PINOLE VALLEY RD
Practice Address - Street 2:WOMEN'S HEALTH
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1384
Practice Address - Country:US
Practice Address - Phone:510-243-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143383207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology