Provider Demographics
NPI:1811620800
Name:WIRFEL, RANDI KAITLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:KAITLIN
Last Name:WIRFEL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2565 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1066 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3812
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2023-11-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant