Provider Demographics
NPI:1558409292
Name:TRITTELVITZ, RENATE (MD)
Entity Type:Individual
Prefix:
First Name:RENATE
Middle Name:
Last Name:TRITTELVITZ
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 1:177 BOVET RD FL 6
Mailing Address - Street 2:CD BILLING; BOVET PROF CENTER
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3116
Mailing Address - Country:US
Mailing Address - Phone:701-255-9279
Mailing Address - Fax:701-222-4142
Practice Address - Street 1:550 HAMILTON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2010
Practice Address - Country:US
Practice Address - Phone:650-485-2102
Practice Address - Fax:650-485-2103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0549872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF96126Medicare UPIN
CA00A549870Medicare ID - Type Unspecified