Provider Demographics
NPI:1184735201
Name:WITCZAK, IZABELA (MD)
Entity type:Individual
Prefix:DR
First Name:IZABELA
Middle Name:
Last Name:WITCZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IZABELA
Other - Middle Name:
Other - Last Name:WLOCHINSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3082
Mailing Address - Country:US
Mailing Address - Phone:858-259-5655
Mailing Address - Fax:858-259-5638
Practice Address - Street 1:150 VALPREDA RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2973
Practice Address - Country:US
Practice Address - Phone:760-736-6700
Practice Address - Fax:760-736-8740
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21575Medicare UPIN