Provider Demographics
NPI:1649563131
Name:WITTBOLDT-MUELLER, HASSO (ND)
Entity Type:Individual
Prefix:MR
First Name:HASSO
Middle Name:
Last Name:WITTBOLDT-MUELLER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LOOTENS PLACE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-456-0381
Mailing Address - Fax:
Practice Address - Street 1:1010 LOOTENS PLACE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-456-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist