Provider Demographics
NPI:1932310406
Name:SARATOGA WALK IN CLINIC
Entity Type:Organization
Organization Name:SARATOGA WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:WETTERHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-446-4774
Mailing Address - Street 1:14054 ALTA VISTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070
Mailing Address - Country:US
Mailing Address - Phone:408-867-1007
Mailing Address - Fax:408-867-4459
Practice Address - Street 1:12224 SARATOGA SUNNYVALE ROAD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070
Practice Address - Country:US
Practice Address - Phone:408-446-4774
Practice Address - Fax:408-446-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42248Medicare UPIN