Provider Demographics
NPI:1841340452
Name:WITLIN, STEVEN N (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:N
Last Name:WITLIN
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 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:310-845-9311
Mailing Address - Fax:310-845-9523
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-845-9311
Practice Address - Fax:310-845-9523
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC18702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31317Medicare UPIN
CAC18702Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER