Provider Demographics
NPI:1992850556
Name:LOIZEAUX-WITTE, JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:LOIZEAUX-WITTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6621
Mailing Address - Country:US
Mailing Address - Phone:310-836-1574
Mailing Address - Fax:310-836-6925
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-836-1574
Practice Address - Fax:310-836-6925
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG823212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48764Medicare UPIN
CAW13956Medicare PIN
CAHW8434Medicare PIN
CAHW13956Medicare PIN
CAWG82321DMedicare PIN