Provider Demographics
NPI:1013909621
Name:WERTZ, ANDREW WILLIS (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:WILLIS
Last Name:WERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 GATEWAY OAKS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3668
Mailing Address - Country:US
Mailing Address - Phone:916-887-7398
Mailing Address - Fax:916-503-3886
Practice Address - Street 1:2825 CAPITOL AVE FL 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6039
Practice Address - Country:US
Practice Address - Phone:916-887-0104
Practice Address - Fax:916-887-0112
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC344292080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C344290Medicaid
CA00C344290Medicaid
A35619Medicare UPIN